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HISTORY OF THE GREAT WAR

BASED ON OFFICIAL DOCUMENTS

MEDICAL SERVICES
GENERAL HISTORY

VOL. Ill

Medical Services during the Operations on
the Western Front in 1916, 1917 and 1918 ;
in Italy; and in Egypt and Palestine.

Major-General Sir W. G. MACPHERSON,

K.C.M.G., C.B., LL.D.

I'll 1 !

LONDON:

PRINTED & PUBLISHED BY HIS MAJESTY'S STATIONERY OFFICE

To be purchased through any Bookseller or directly from H.M. STATIONERY OFFICE

at the following addresses: Imperial House, Kingsway, London, W.C.2. and

28, Abingdon Street, London, S.W.i ; York Street, Manchester;

1, St. Andrew's Crescent, Cardiff; or 120, George Street, Edinburgh.

I924.

Price £1 Is. Qd.

CONTENTS.

CHAPTER

II.

III.

IV.

VI.

VII.

VIII.

IX.

XI.

XII.

XIII.

XIV.

XV.

XVI.

XVII.

XVIII.

XIX.

XX.

XXI.

XXII.

List of Sketch Maps, Charts, etc.

List of Abbreviations

Preface

Minor Actions in 1916

The Somme Battles of 1916

The Advance to the Hindenburg Line in 1917

The Battle of Arras, 1917

The Battle of Vimy Ridge

The Flanders Offensives in 1917

The Battle of Messines

The Battles of Ypres, 1917

The Battle of Hill 70, August 1917

The Dunkirk-Nieuport Area, 1917

The Cambrai Operations in 1917. .

The German Offensive in 1918

The German Offensive against the Fifth Army in 1918

The German Offensive against the Third Army in 1918

The German Offensive on the Lys in 1918

The British Medical Services with the French on the

Aisne and the Marne, May to August 1918
The Medical Services during the Advance to Victory
The Medical Services with the British Forces in Italy
The Medical Services in Egypt
The Medical Services during the Operations against

the Followers of the Senussi and Sultan of Darfur
The Medical Services during the Operations in the Sinai

Peninsula
The Medical Services during the Operations in Palestine

Appendix A. 1,

Medical Units with the British Expeditionary
Force on the Western Front

Appendix
Appendix

Medical Units with the British Expeditionary
Force in Italy
3. Medical Units with the British Expeditionary
Force in Egypt and Palestine . .

B. Casualties during the Somme Battles, 1916

C. Daily Admissions to Field Ambulances and

Casualty Clearing Stations during the Advance
to Victory..

Index

PAGE

iii

viii

112

120

137

172

175

183

201

212

232

249

273
291
327
362

394

409
436

485
507

510

522

528
541

SKETCH MAPS.

Position of Medical Units during Actions at The Bluff,

March-April 1916

Medical Situation, 3rd Division and 2nd (Canadian)

Division. Actions of St. Eloi Craters, March- April

1916

Position of Medical Units during German Attack on

Vimy Ridge, 21st May 1916

Position of Medical Units during Battle of Mount Sorrel,

2nd-13th June 1916

Battle of the Somme. Subsidiary Action at Fromelles,

July 1916

Somme Battle Area, 1916

Battle of the Somme. Situation of Medical Units,

Fourth Army, on 1st July 1916
Battle of the Somme. Situation of Medical Units of

Fourth and Fifth Armies on 30th November 1916
The Advance to the Hindenburg Line. Ilnd Corps

Front, April 1917

Medical Situation of the Battles of Arras and Vimy

Ridge, April 1917

Battle of Arras. Vllth Corps Front, April 1917

Battle of Arras. VI th Corps Front, April 1917

Battle of Arras, April 1917. Scarpe Valley Operations

Battle of Vimy Ridge. Canadian Corps Front. .

Battle of Vimy Ridge. XHIth Corps Front

Battle of Vimy Ridge. 1st Corps Front

Battle of Messines, June 1917. General Situation of

Medical Units, Second Army
Battle of Messines. Map of Medical Situation, Front

Area, 36th Division, showing System of Relay Posts . .
Battles of Ypres, 1917. General Situation of Medical

Units of Fifth Army on 31st July 1917
Battles of Ypres, 1917. Medical Organization, Ilnd

Corps, Front Area, on 31st July
Battles of Ypres, 1917. Medical Situation, XlXth

Corps, Front Area, on 31st July
Battles of Ypres, 1917. Medical Situation, XVIIIth and

XlVth Corps, Front Area, on 31st July
Medical Situation on the Coast Area, June-October

1917. Fourth Army and XVth Corps
Medical Situation, Battle of Cambrai, November 1917. .
Medical Situation in the IVth and Illrd Corps during

the Battle of Cambrai, November 1917
Sketch Map showing the Relative Positions of Casualty

Clearing Stations and Hospitals to the Front Line

during the Period of Defence previous to the German

Offensive in 1918

Movement of Casualty Clearing Stations of Fifth Army

during German Offensive, Spring of 1918
Movement of Casualty Clearing Stations of Third Army

during German Offensive, Spring 1918

(10134) Wt. 2484/5060/141 1500 3/24 Harrow G.45 P.21/4.

PAGE

*n text

» >

> >

To face

8
12

»»

> »

In text

To face
In text

66
72
76
91
97
101
105

To face

121

In text

131

To face

139

In text

145

149

152

To face

177
185

189

206
213
233

Sketch Maps — continued.

PAGE

Movement of Casualty Clearing Stations of First and
Second Armies during the German Offensive on the
Lys, 1918 To face 251

Sketch Map of Medical Situation of French Sixth Army

on the Aisne, 20th May 1918 , 274

Medical Situation of the British IXth Corps with the
French Sixth Army on the Aisne, German Offensive,
27th May 1918 „ 275

Sketch Map of the Medical Situation of the British
IXth Corps with the French Sixth Army on the
Aisne during the German Offensive, May- June 1918 ,, 277

Sketch Map showing Positions of Medical Posts of the
51st and 62nd Divisions (XXIInd Corps) with the
French Sixth Army, during Operations of July 1918
on the Eastern Flank of the Marne Salient . . In text 282

Sketch Map showing Positions of Medical Posts of the
15th and 34th Divisions with the French Groupe
d'Armees de Reserve on the Western Flank of the
Marne Salient during Operations of July 1918 . . ,, 288

Sketch Map showing the Movements of Casualty

Clearing Stations during the Advance to Victory . . To face 297

Medical Arrangements on the Mediterranean Line of

Communication, French Section . . . . . . „ 328

Medical Arrangements on the Mediterranean Line of

Communication, Italian Section . . . . . . ,, 329

Sketch Map of Positions of Medical Units with British

Artillery on the Carso Front . . . . . . . . ,, 331

Medical Situation on the British Lines of Communication

from the Front in Italy to Marseilles during 1918 . . ,, 335

Map of Positions of Casualty Clearing Stations on the

Italian Front „ 340

Medical Situation in the British XlVth Corps on the

Asiago Front in June 1918 . . . . . . . . ,, 343

Medical Situation in the 48th Division during the

Austrian Offensive of 15th June 1918 . . . . „ 345

Medical Situation on the Piave Front previous to the
Advance of the 7th and 23rd Divisions, October-
November 1918 „ 349

Medical Situation of the 7th Division at the Passage

of the Piave in October 1918 „ 350

Medical Situation of the 23rd Division during the Final

Operations on the Piave, October 1918 . . In text 352

Medical Situation during the advance of the 48th
Division from the Asiago Plateau, October-November
1918 „ 355

Map of Egypt, showing Areas of Operations . . . . To face 364

Operations against the Sultan of Darfur, 1916 . . . . In text 406

Map of Operations in the Sinai Peninsula . . . . To face 410

General Map illustrating Operations in Palestine . . ,, 437

Medical Situation, XXth Corps, 30th October 1917,

previous to Attack on Beersheba and Sheria . . ,, 448

Sketch Maps — continued.

PAGE

Medical Situation, XXIst Corps, 6th November 1917,

previous to Capture of Gaza . . . . . . To face 450

Medical Situation in Palestine at end of 1917 . . . . ,, 453

Map showing Medical Situation in Palestine previous

to Final Battles in September 1918 . . . . ,, 457

Medical Situation during the Raids on Es Salt and

Amman . . . . . . . . . . . . . . ,, 466

General Scheme of Evacuation during Pursuit to

Aleppo . . . . . . . . . . . . In text 481

CHARTS AND DIAGRAMS.

Charts showing Movements of Corps and Divisions

during the Battle of the Somme, 1916 .. .. To face 14

Chart showing Daily Admissions into Field Ambulances

for Wounds, Battle of the Somme, 1916 .. .. „ 51

Chart showing Vacant Beds in L. of C. Hospitals and
Convalescent Depots in France during the Prepara-
tions for the Spring Offensive of 1917. . . . . . ,, 56

Plan of " Thompson's Cave," Battle of Arras, 1917 . . In text 75

Battle of Arras. Plan of Standard R.A.P. dugout used

by the 34th Division „ 93

Battle of Vimy Ridge. Diagram of Xlllth Corps

Evacuation Organization, April 1917.. .. .. ,, 102

Diagram showing Xth Corps Scheme of Evacuation
of Casualties in Preparation for the Battle of
Messines, June 1917 To face 133

Scheme of Evacuation of Wounded from the 23rd

Division during the Battle of Messines . . . . ,, 134

Scheme of Evacuation of Sick and Wounded from
IVth and Hlrd Corps during the Battle of Cambrai,
November 1917 „ 188

Diagram showing the First and Second Systems of
using cars of No. 31 Motor Ambulance Convoy with
the XVIIIth Corps, during German Offensive in 1918 In text 224

Chart showing Daily Totals of Admissions to Casualty
Clearing Stations of the First, Second, Third, Fourth
and Fifth Armies during " The Advance to Victory,
1918" To face 323

Chart showing the number of Hospital Beds at the

Marseilles Base for the British Forces in Italy . . In text 357

Chart showing the number of Hospital Beds vacant in
Italy and Marseilles Base, and the number of Sick
and Wounded awaiting Evacuation from Italy . . To face 360

Chart showing the Changes which took place in the
Designations of certain Field Ambulances during the
Egyptian and Palestine Operations . . . . . . ,, 372

PHOTOGRAPHS.

Seventy-nine Photographs illustrating Chapters II-VI, VIII, XV-XIX,

XXI and XXII.

ABBREVIATIONS.

A.A.M.C. . . Australian Army Medical Corps.

A.D.G. . . Assistant Director-General.

A.D.M.S. . . Assistant Director of Medical Services.

A.D.R.T. . . Assistant Director of Railway Transport.

A.D.S. . . Advanced Dressing Station.

A.D.Tn. . . Assistant Director of Transportation.

A.G. . . Adjutant-General.

A.M.S. . . Army Medical Service.

A.O.C. . . Army Ordnance Corps.

A.Q.M.G. . . Assistant Quartermaster-General.

A.S.C. . . Army Service Corps.

A.T. . . Ambulance Train.

A.V.C. . . Army Veterinary Corps.

B.R.C.S. . . British Red Cross Society.

C.A.M.C. . . Canadian Army Medical Corps.

C.A.S.C. . . Canadian Army Service Corps.

C.C.H. . . Combined Clearing Hospital.

CCS. . . Casualty Clearing Station.

C.F.A. . . Cavalry Field Ambulance.

CM.D.S. . . Corps Main Dressing Station.

CP. . . Collecting Post.

C.W.W.S. . . Corps Walking Wounded Station.

D.A. & Q.M.G. Deputy Adjutant and Quartermaster-General.

D.A.D.M.S. . . Deputy Assistant Director of Medical Services.

D.D.M.S. . . Deputy Director of Medical Services.

D.D.G. . . Deputy Director-General.

D.D.G.A.M.S. Deputy Director-General, Army Medical Service.

D.D.G.M.S. . . Deputy Director-General of Medical Services.

D.G. . . Director-General.

D.G.A.M.S. . . Director-General, Army Medical Service.

D.G.M.S. . . Director-General of Medical Services.

D.M.S. . . Director of Medical Services.

D.R.T. . . Director of Railway Transport.

D.Tn. . . Director of Transportation.

E.M.O. . . Embarkation Medical Officer.

E.P.I. P. . . European Privates' Indian Pattern Tent.

F.A. . . Field Ambulance.

Vll

Abbreviations — continued .

F.A.N.Y.

First Aid Nursing Yeomanry.

G.A.R.

Groupe d'Armees de Reserve.

G.H.Q.

. . General Headquarters.

G.O.C.

General Officer Commanding.

G.R.O.

General Routine Order.

G.S.O.

. General Staff Officer.

I.G.C.

Inspector-General of Communications.

I.M.S.

Indian Medical Service.

I.S.M.D.

. Indian Subordinate Medical Department.

L. of C.

. Lines of Communication.

M.A.C.

Motor Ambulance Convoy.

M.D.S.

Main Dressing Station.

M.O.

. Medical Officer.

M.T.

. Mechanical Transport.

N.C.O.

Non-Commissioned Officer.

N.Y.D.N.

Not yet diagnosed (nervous) .

N.Z.M.C.

New Zealand Medical Corps.

O.C.

. Officer Commanding.

O.R.

Other Ranks.

P.B.

Permanent Base.

P.D.M.S.

Principal Director of Medical Services.

P.U.O.

Pyrexia of uncertain origin.

Q.A.I.M.N.S.

Queen Alexandra's Imperial Military Nursing Service

Q.M.G.

Quartermaster-General.

R.A.F.

Royal Air Force.

R.A.M.C.

Royal Army Medical Corps.

R.A.P.

. Regimental Aid Post.

R.E.

Royal Engineers.

R.H.A.

Royal Horse Artillery.

R.H.G.

Royal Horse Guards.

R.N.

. Royal Navy.

R.P.

Relay Post.

R.T.O.

Railway Transport Officer.

S.A.M.C.

South African Medical Corps.

S.M.O.

. Senior Medical Officer.

S.O.

Sanitary Officer.

T.A.T.

Temporary Ambulance Train.

T.F.

Territorial Force.

V.A.D.

Voluntary Aid Detachment.

W.W.C.P.

Walking Wounded Collecting Post.

Y.M.C.A.

Young Men's Christian Association.

Vlll

PREFACE.

THE chapters in this volume have been compiled mainly
from the War Diaries and Official Despatches, but
owing to many of the former being missing, a considerable
amount of information in connexion with the chapters on
the medical services in Egypt and during the Sinai and
Palestine operations has been obtained from officers who
held administrative medical appointments during these
operations, chiefly from Major-General Sir R. Ford, who was
the Director of Medical Services in Egypt, from Sir R. Luce
and from Lieut. -Colonel J.J. Abraham, the Assistant Director
of Medical Services on the Palestine Lines of Communication.

The majority of the small photographs in the text,
illustrative of various situations of divisional medical services
on the Western Front, have been obtained from Captain
R. T. Bruce, who served with a field ambulance of the 51st
(Highland) Division. Several of the photographs in the text
of the preceding volume were also obtained from this officer.

The other photographs are from official sources, several
of them, notably those in the chapter on the Medical
Services in Italy, having been supplied by Lieut. -Colon el
F. S. Brereton, who visited areas of operation with a view
to obtaining material for the Imperial War Museum and the
Medical History of the War.

The compiler is again deeply indebted to Brig.-General
J. E. Edmonds, the Director of the Military Branch of the
Historical Section of the Committee of Imperial Defence,
for his valuable assistance in reading through the manuscript.

The limitations of time and space, which had been imposed
for the completion of the Medical History of the War, made
it difficult to introduce incidents that would render this and
other volumes more attractive to the general reader. All
that has been attempted therefore has been to provide a
basis on which those who are desirous of studying more
closely the medical situation during the various battles and
phases of the war may be able to reconstruct with the aid
of the maps the chief features of the work of the medical
services.

General Staff maps, 1 in 250,000, of the Western Front,
will be found in Volume II of the General History of the
Medical Services.

August 1923 W. G. M.

CHAPTER I.

MINOR ACTIONS IN 1916.

N addition to the major operations during the period of
trench warfare in 1915, described in the preceding volume,
the medical services were actively engaged in various minor
operations in the southern area of the Ypres Salient and on
the Vimy Ridge in the earlier months of 1916. The following
is a short account of those minor actions, which took place
before the battles of the Somme in the later months of the year

Actions of the Bluff.

During the night of the 14th/ 15th February 1916 the enemy
exploded a mine on the front of the 17th Division at the Bluff,
north of St. Eloi ; five sections of trench were lost. Fighting
was continued on the 16th February, but the counter-attacks
made to regain the lost ground were unsuccessful. Operations
then died down until the 1st March, when the 8th Brigade
of the 3rd Division, with four medical officers and 156 stretcher
bearers and 1 1 cars, was transferred to the Vth Corps to make
a combined attack with the 17th Division on the Bluff. The
attack was made at 4.30 a.m. on the 2nd March and the lost
ground retaken. Fighting was continued until the 3rd March,
when the situation again became normal.

The weather was variable and generally cold, with high
winds and occasional rain.

The medical arrangements worked smoothly and well, but
with considerable losses amongst the personnel. The stretcher
bearers had great difficulty in bringing back the wounded
from the regimental aid post and the advanced dressing
station at Bedford House, a distance of one and a half to one
and three-quarters of a mile, the only approach being across
open country which was exposed to heavy shell-fire ; in fact,
at times bearers attempting to get across were fully employed
in bringing back their own wounded comrades. The stretcher
bearers worked steadily day and night and were reinforced
by the four officers and 156 other ranks of the 3rd Division
field ambulances. One of the stretcher bearers was killed
and sixteen wounded. The motor ambulance cars ran up
through Ypres and down the Lille road to Bedford House.
They continued running both night and day under frequent

10134 B

2 MEDICAL HISTORY OF THE WAR

and heavy shell-fire. Four of the ambulance cars were damaged
by shell-fire, and four of the drivers wounded. The positions
of the various medical posts are shown on the following sketch
map.

Position or Medical Units durimq actions at The Bluff, March-April 1916.

^ResM/v-rt-J^of^oarr. \&Adv.Dr£Ssinq Station. C3 Main Dkessinq Station.

BrandhOj

-re— <

SOWr

CoJ/et
Post.

Reninghelst

WPfr.

77r"Div.

In these operations the benefit of the steel helmet, which
was by this time being issued to the troops, was especially
brought to notice. Twenty-six cases came under observation,
in eight of which the helmet had been pierced. In one case
a shrapnel bullet had penetrated the helmet. It was found
arrested in the metal, and had produced no wound. In twelve
cases the helmets had evidently sufficient stopping power to
prevent a fatal result. In six cases the helmet had been badly
dented but no injury had been caused.

At an advanced dressing station of the 17th Division a
record had been kept of the proportion of lying, sitting and
walking cases received between 4 a.m. on the 2nd March and
4 a.m. on the 5th March. The record is of value. It showed
that the proportion was 240 lying, 438 sitting and 427 walking
cases.

There were several casualties from air raids. During one
of these air raids on the 18th February 1916 a bomb was
dropped in the Wippenhoek area on the divisional rest station
of the 50th Division.

Actions of St. Eloi Craters.

Between the 27th March and 16th April 1916 there was
continual fighting in the vicinity of St. Eloi. Several mines had
been exploded successfully on the 3rd Division front in the early
morning of the 27th March and about 160 prisoners captured.

MINOR ACTIONS IN 1916 3

The 3rd Division continued to hold the positions captured
until the 5th April, when they were withdrawn to a rest area
of the Vth Corps on relief by the 3rd Canadian Division.
This division was attacked on the night of the 5th/6th April ,
and some of the ground which had been taken by the 3rd
Division was lost. Fighting was continued then in this area
until the 16th April.

The following sketch map indicates the positions of the
medical units during these operations.

Medical. Situation 3 rd Div. and2 nd (cdn)Div.
Actions St. Eloi Craters, March-April. 1916.

4- Rcg.Aio fhsr. Q Advanced DrcsswoSta. fffl Main Dkessins Sta .

Scafe. ^

&&%?**

iLoCKC.

St. Jans

LlNOKNHOeK.

iDranoutre.

Z".dfCdn) gnj -w

The wounded admitted to the field ambulances of the Vth
Corps between the 27th March and 5th April 1916 numbered
1,290, of whom 523 were admitted on the 28th March, and
129 on the following day.

The 2nd Canadian Division was at the time on the immediate
right of the 3rd Division, and was the only Canadian division
that took part in the first phase of the operations.

The 3rd Canadian Division, which took over the 3rd Division
front on the 5th April, had arrived in France without its field
ambulances, but each of the other two divisions of the Canadian

10134

MEDICAL HISTORY OF THE WAR

Corps, the 1st and 2nd Canadian Divisions, carried on with
only two field ambulances each and transferred their third
field ambulance to the 3rd Division. Casualties in the Canadian
Corps between the 1st and 16th April 1916 were as follows : —
1st Canadian Division . . . . . . 281

2nd Canadian Division . . . . . . 917

3rd Canadian Division . . . . . . 206

Total 1,404

The largest number occurred on the 7th April, when 370
wounded were admitted into the field ambulances.

German Attack on Vimy Ridge.

On the 15th May 1916 the 25th Division exploded three
mines in front of its trenches in the Vimy Ridge area and
occupied the craters and part of the German trench system in
that area. This was followed on the afternoon of the 21st
May by a German counter-attack, preceded by artillery bom-
bardments during which lachrymatory shells were used, the
effects of them being felt about three miles behind the front
line. The counter-attack was made against the junction of
the First and Third Armies between the Lens-Arras road in
front of Xeuville St. Vaast, to the south-east of Souchez.

The 25th Division of the XVIIth Corps (Third Army)
occupied the right sector in this area, and the 47th Division of
the IVth Corps (First Army) the left sector.

The German counter-attack had been successful in capturing
some of the trenches of this line, and on the afternoon of the
22nd May 1916 two brigades of the 2nd Division were sent to
assist the 47th Division in an effort to regain the captured
trenches on the night of the 22nd/23rd. This attack, however,
failed to drive the enemy from the captured trenches, and
the 47th Division was relieved by the 2nd Division on the
25th May. Wounded admitted to the field ambulances during
these operations were as follows : —

Division.

22nd.

23rd.

24th.

25th.

47th Division

2nd Division

25th Division

—

576
36

288

256

195

384
30
38

Totals

—

900

548

452

MINOR ACTIONS IN 1916

The positions of the medical units are shown in the following
sketch map.

Position of Mecncai. Units during German attack on
Vimy Ridge SI*:* May 1916.

+&£6mtl. Aid Post QAov.DnESSiNeSrA. ^MuvDtfssJNeSTA.

U ' ' LLl ' ?

^c*fa of mi/cs>

Co Savins.

i-ca 4- Vc-.-rrs.

RoCUNC©U*T.

Q'v- Qy 3r Au sim.

Evacuation proceeded steadily and satisfactorily. There
was no incident requiring special record in connexion with
these operations, and there were no casualties amongst the
medical units.

Battle of Mount Sorrel.

A battle of greater magnitude was fought between the 2nd
and 13th June 1916 in the area east of Ypres between the
Ypres-Comines Canal and the Ypres-Roulers railway, to which
the name of the Battle of Mount Sorrel has been given. The •
enemy attacked a line held by the 3rd Canadian Division
from Mount Sorrel, about 1,000 yards south-east of Zillebeke
and Hooge, and captured the trenches. A counter-attack
was made by the 1st Canadian Division and the lost trenches
were recaptured on the 13th June. The corps engaged was
the Canadian Corps, with Colonel G. La F. Foster, who arrived

MEDICAL HISTORY OF THE WAR

in France as A.D.M.S. of the 1st Canadian Division, as its
D.D.M.S. The casualties were extremely heavy, especially
in the 3rd Canadian Division during the first half < ,f the fighting,
and in the 1st Canadian Division during the second half, as
is shown in the following table of the numbers received into
the field ambulances : —

Division.

June
2nd to 8th.

June
9th to 15th.

Total.

1st Canadian

2nd Canadian

3rd Canadian

Canadian Corps Troops

20th Division

1,360
391

2,429
35
85

1,567

419

273

2,927
810

2,702
53
85

Totals

4,300

2,277

6,577

This total is made up of 227 officers and 6,350 other ranks.

The casualties in the medical services were heavy, Lieut.-
Colonel A. W. Tanner, commanding No. 10 Canadian Field
Ambulance, being killed, and two other Canadian medical
officers missing, a quartermaster of No. 8 Canadian Field
Ambulance wounded, and an officer of No. 1 Canadian Field
Ambulance evacuated suffering from shell-shock. Four other
ranks of the R.A.M.C. or C.A.M.C. were killed, thirty of the
C.A.M.C. wounded, and eight attached drivers of the A.S.C.
or C.A.S.C. wounded ; two other ranks of the C.A.M.C. were
also missing.

Remy Siding had by this time become a large casualty
clearing station centre, with No. 10, No. 17 and No. 3 (Canadian)
Casualty Clearing Stations, and the casualties were evacuated
from the field ambulances to this centre.

The whole neighbourhood of the advanced dressing station
at the Asylum, Ypres, was shelled heavily during the evening
of the 2nd June. Several of the motor ambulance drivers
and motor cyclists were wounded, and evacuation from the
Asylum was being retarded. It was decided, consequently,
to clear direct to the main dressing station at Brandhoek,
without using this dressing station. It was at this time
that Lieut. -Colonel Tanner, who was commanding No. 10 Field
Ambulance in the Asylum dressing station, was fatally
wounded by a shell while directing the loading of ambulance
cars in the courtyard.

MINOR ACTIONS IN 1916 7

The field ambulances of the 3rd Canadian Division, during
the first thirty-six hours of this battle, evacuated some 2,000
cases from the fighting area to the main dressing station at
Brandhoek, a good record for units so newly arrived in
France, one of which had never had any experience of front
line work and had never been under fire previously.

The work of the motor ambulance drivers was of a very
arduous nature. The roads were heavily shelled and almost
impassable in the darkness, but against such odds the men
continued taking their cars regularly to and fro, and con-
tributed largely to the successful evacuation of such a large
number of wounded in so short a space of time.

Position of Medical Units during Battle of Mount Sorrel, June Z. H ?-lS r ^ \9\6.

+ ReeMNTL.. Aid Post. Q Adi/awc£o Dressing Station PJJ Main Dk^ssing Station

*S ld/7i q

Most of the regimental medical officers had to leave their
original aid posts, evacuating all their wounded and taking
up on their own initiative new positions further back, where
they carried on until the battalions were withdrawn.

The advanced dressing station of No. 10 Canadian Field
Ambulance at Maple Copse was under terrific shell-fire. The
wounded were cleared from it as rapidly as possible and the
advanced dressing station removed to the Menin Mill, on the
Menin road, 1,000 yards east of the Menin Gate of Ypres.
A new advanced dressing station at Zillebeke dugouts was
also established by the same unit along with No. 9 Canadian
Field Ambulance, through which some 1,200 to 1,300 cases
were passed.

Action at Fromelles.
While major operations were being conducted in the
Somme area, the Second and First Armies were engaged
in a subsidiary action at Fromelles on the Aubers Ridge front
on the 19th July 1916

MEDICAL HISTORY OF THE WAR.

The attack was made about 6 p.m. by the 5th Australian
Division of the Ilnd Anzac Corps, then in the Second Army,
in conjunction with the 61st Division of the XI th Corps of
the First Army on its right. The 5th Australian Division
had only recently arrived in France from Egypt, where it had
been organized, and had taken over the line from the 4th
Australian Division on the 12th of the month. The A.D.M.S.,
Colonel C. H. W. Hardy, had made elaborate arrangements
for the attack, as shown in the following sketch of the disposition
of his field ambulances. He had two main dressing stations,

Battle of the Somme
Subsidiary action at Fromelles, July 1916

•fr Zeqmntl.A/dfhst.

O Adv- Dressing Sta.

[J Afav'n Dr&ss/ngSta.

one at Fort Rompu, between Bac St. Maur and Armentieres,
and the other at a factory at Bac St. Maur> with a series of
five advanced dressing stations, three of which were advanced
a few hours after the attack had been launched to positions
further forward. The motor ambulance cars of the division
had not arrived by the time of this attack, and 21 motor
ambulance cars had to be given to it from No. 14 M.A.C.

Apparently the 61st Division did not advance on the right
flank as far as did the 5th Australian Division, with the result
that the latter had a very large number of casualties from
enfilade fire, several of whom were collected from No Man's
Land during the days following.

MINOR ACTIONS IN 1916

The total casualties in killed, wounded and missing in the
5th Australian Division amounted to almost 50 per cent, of
the troops engaged, the figures being as follows : —

Officers.

Other ranks.

Total.

Killed

Wounded
Missing

102

476
1,655
3,224

506
1,700
3,326

Total

177

5,355

5,532

Owing to the small number of casualties on the left flank
of the division, and their concentration in the centre and right
flank, the work of the field ambulances and stretcher bearers
on the right flank became overpowering, and all the available
personnel and stretchers of No. 8 Australian Field Ambulance,
which had formed posts on the left flank, were transferred to
assist on the right flank and centre. The A.D.M.S. of the New
Zealand Division was also asked to assist, and sent forward
2 medical officers, 40 other ranks, and 7 motor ambulance
cars at 12.30 a.m. on the morning of the 20th.

The officers commanding the field ambulances kept careful
records of the nature of the wounds, of which the following
statement is of interest as indicating their location : —

Percentage of wounds according to locality.
Head and neck . . .. 16-67 per cent.

Thorax

7-93

Upper extremities

31-79

Abdomen

4-27

Lower extremities

31-00

Back

2-22

" Shell Shock "

6-12

100-00

The number of wounded for transport, walking, sitting and
lying down, was also recorded as follows, between noon on
19th July and 8 p.m. of 21st July :—

Field Ambulance.

Walking.

Sitting.

Lying down.

Total.

No. 8 Australian . .
No. 14
No. 15

453
347

211
324
373

358
637
557

586
1,414
1,277

Total

817

908

1,552

3,277

10 MEDICAL HISTORY OF THE WAR

The number of wounded admitted to the field ambulances
of the 61st Division was approximately 934. Their collection
and evacuation were carried out without difficulty and smoothly.
The stretcher cases were brought to regimental aid posts at
Red House and Hougomont by regimental stretcher bearers
on stretchers or wheeled stretcher carriers. The light cases
went on foot to a collecting station at Laventie East, and were
taken thence in horse ambulance wagons to a walking wounded
dressing station at La Gorgue established by a detachment of
the 2/3rd South Midland Field Ambulance. From there they
were conveyed in cars of No. 13 M.A.C. to No. 9 and the West
Riding Casualty Clearing Stations in Lillers, where they
entrained. The stretcher cases were taken to an advanced
dressing station at Laventie, and were then removed in the
motor ambulance cars of the field ambulances to a main
dressing station at La Gorgue, where a tent division of the
2/ 1st and 2/3rd South Midland Field Ambulances was employed.
They were conveyed thence by No. 2 M.A.C. to No. 7 and No. 2
London C.C.Ss. at Merville for entraining.

There was no further incident of note during this subsidiary
action, and the front over which the attack was made became
quiet immediately afterwards.

CHAPTER II.

THE SOMME BATTLES OF 1916.

THE succession of fiercely fought battles which com-
menced on the British and French front in the area
of the Somme and Ancre on the 1st July 1916 lasted until
towards the end of November.

The line from which the British divisions launched their
attack extended from Maricourt Wood, just north of the Somme,
to Gommecourt, where the enemy's trench line formed a small
salient. The French held the line on the right from Maricourt
Wood to the Somme and south of the Somme. The Vllth
Corps of the Third Army was in front of the Gommecourt
salient on the left ; but the remainder of the line from Maricourt
to Hebuterne was held by the Fourth Army, under General
Sir H. Rawlinson, whose D.M.S. was Surg. -General M.
O'Keeffe, with Lieut. -Colonel H. B. Fawcus as his A. D.M.S.

A reserve army, under General Sir Hubert Gough, with
Surg.-General C. E. Nichol as D.M.S., had its headquarters
at Daours on the Somme, between Corbie and Amiens, previous
to the battles.* It consisted at the time the battle commenced
of the 1st and 3rd Cavalry Divisions and the 2nd Indian
Cavalry Division only.

The Fourth Army had five corps in the line. From right
to left they were the XHIth, under Lieut. -General W. N.
Congreve, with Colonel G. Cree as his D. D.M.S. ; the XVth,
under Lieut. -General H. S. Home, with Colonel F. Newland
as his D. D.M.S. ; the Illrd Corps, under Lieut. -General Sir
W. P. Pulteney, with Colonel B. M. Skinner as D.D.M.S. ;
the Xth Corps, under Lieut. -General Sir T. L. N. Morland,
with Colonel R. Macleod as D.D.M.S. ; and the VHIth, under
Lieut. -General Sir A. G. Hunter-Weston, with Colonel J. B.
Wilson as D.D.M.S.

The Vllth Corps of the Third Army, under Lieut. -General
Sir T. D'O. Snow, with Colonel W. T. Swan as D.D.M.S., held
the line from which the attack on the Gommecourt salient
was to be made.

* A change in the medical administration of the Reserve, then designated
the Fifth, Army, took place on the 1st November, when Colonel B. M. Skinner,
from D.D.M.S. of the Illrd Corps, became the D.M.S. of the Army, with the
temporary rank of Surg.-General.

12 MEDICAL HISTORY OF THE WAR

The XHIth Corps front, with its headquarters at Corbie,
extended from the wood north-east of Maricourt to the north
of Caftet Wood, and included the village of Carnoy in its area.
The divisions holding this line were the 30th (A.D.M.S., Lieut. -
Colonel J. D. Alexander) and the 18th (A.D.M.S., Lieut. -
Colonel J. Poe).

The line of the XVth Corps extended from the left of the
XHIth Corps south-east of Mametz and Fricourt to a point
north of Becourt about one and a half miles due east of the
town of Albert. It was held by the 7th Division (A.D.M.S.,
Lieut.-Colonel A. W. Hooper) and the 21st Division (A.D.M.S.,
Colonel C. W. Profeit).

The Illrd Corps front on the left of the XVth Corps crossed
the Albert-Bapaume road just west of La Boisselle to east of
Authuille. It was held by the 34th Division (A.D.M.S.,
Colonel J. J. Gerrard) and the 8th Division (A.D.M.S., Colonel
H. N. Dunn).

From there the line of the Xth Corps ran between Thiepval
and Thiepval Wood and extended to the right bank of the
Ancre just north of Llamel. It was held by the 32nd Division
(A.D.M.S., Colonel P. Evans) and the 36th Division (A.D.M.S.,
Colonel F. J. Greig).

The line of the VHIth Corps from there ran northwards
half-way between Beaumont Hamel and Auchonvillers to the
west of Serre just south-east of Hebuterne. It was held by
the 29th Division (A.D.M.S., Colonel S. G. Moores), the 4th
Division (A.D.M.S., Lieut.-Colonel J. Grech) and the 31st
Division (A.D.M.S., Colonel A. W. Bewley).

The Vllth Corps held the trenches opposite Gommecourt
to the south of Monchy au Bois. The divisions in the line
were the 56th Division (A.D.M.S., Colonel E. G. Browne),
the 37th Division (A.D.M.S., Colonel R. W. Wright) and the
46th Division (A.D.M.S., Colonel W. C. Beevor).

Several other divisions were in reserve, namely the 9th, 17th,
19th and 12th, 25th and 49th, and the 48th, in the back areas
of the XHIth, XVth, Illrd, Xth and VHIth Corps.

Outline of the Battles.

The attack on the 1st July resulted in the whole system of
the enemy trenches in front of the XHIth Corps and a portion
of those between Fricourt and La Boisselle in front of the 21st
and 34th Divisions being captured and held ; the line was
thus extended from the Bois de Faviere, north-east of the
Bois de Maricourt, round Montauban and Mametz to the

SOMME BATTLE AREA 1916

M British & French Front Lines 30™ June. 1916.
— British Line /V ' Jufy

Qo /-PVu/y ^-

jO<? /Q t ." September

British 3 French Lines. /7 T ? November .
/Vew Broad Gsuge ff&i'/tvay

Shaded Portion Penates Area of Batt/ e betx££n

the Jnere an d -t he Somm e

Scs/e of Miies

MaJby&Sonslith.

THE SOMME BATTLES OF 1916 13

south of Fricourt, and from the north of Fricourt in a salient
towards the outskirts of Contalmaison to the south of La
Boisselle. A small salient was also made between La Boisselle
and Ovillers la Boisselle. Attacks which had been made on
Fricourt, La Boisselle, Ovillers la Boisselle, Thiepval, Beaumont
Hamel and Gommecourt failed to attain their objectives.

Between the 2nd and 13th July the fighting was continued
until the line was advanced to the edge of Trones Wood and
along the north of Bernafay Wood, Caterpillar Wood and
Mametz Wood. Contalmaison and Ovillers la Boisselle were
also captured and the line continued north of these villages to
the original line east of Authuille Wood.

A second advance was made on the 14th July to Delville
Wood, and included the capture of Longueval, Bazentin le
Grand and Bazentin le Petit. Fierce fighting then took place,
with varying results, to secure the high ground extending
from Guillemont and Ginchy through High Wood to Thiepval.
These objectives, with the exception of Thiepval, were gained
by the 12th September, and the line then held by the British
ran from the west of Combles round Leuze Wood, Ginchy,
Delville Wood, through High W T ood and westwards along the
high ground south of Martinpuich and Courcelette and across
the Albert-Bapaume road north of Pozieres, whence it bent
back to the original line south of Thiepval.

The XHIth Corps had been withdrawn from the line on the
17th August and replaced by the XlVth Corps, under Lieut. -
General the Earl of Cavan, with Colonel Whaite as D.D.M.S.
The Divisions in the XlVth Corps at the time were the 56th
Division (A.D.M.S., Colonel E. G. Browne), the 6th Division
(A.D.M.S., Colonel B. H. Scott) and the Guards Division
(A.DM.S., Colonel G. S. McLoughlin).

On the 15th September the XlVth, XVth and Illrd Corps
continued the attack, using tanks for the first time. The high
ground and the reverse slopes north of Ginchy, Flers, Martin-
puich and Courcelette were gained. The attack was renewed
on the 25th and 26th September, when Combles, Morval,
Lesboeufs, Gueudecourt and Thiepval were captured. Subse-
quent operations between that date and the end of October
resulted in a line being held from the Bapaume-Peronne road
at Sailly Saillisel, and from there westwards between Transloy
and Gueudecourt across the Albert-Bapaume road, just south
of the Butte de Warlencourt, to Thiepval.

The Reserve Army which, as already noted, was in the neigh-
bourhood of Corbie on the 1st July was moved into the area

(10134) c

14 MEDICAL HISTORY OF THE WAR

of the Xth and VHIth Corps on the 6th July and took over
these corps from the Fourth Army, thus coming in between
the Fourth Army and the Third Army. It retained the
designation of the Reserve Army until the 1st November,
when it was named the Fifth Army.

The 1st Anzac Corps, under Lieut. -General Sir W. Birdwood,
with Colonel Manifold, I. M.S. as his D.D.M.S., and composed
of the 1st, 2nd and 4th Australian Divisions, was added to
the Reserve Army on the 18th July. The New Zealand
Division, which had formed part of the Anzac Corps, had been
withdrawn from it and joined the XVth Corps. The XHIth
Corps was transferred to General Gough's army on the 17th
August, and the Xth Corps was withdrawn to Fourth Army
reserve during the same month. During September the 1st
Anzac Corps was withdrawn from the Reserve Army and
replaced by the Canadian Corps, consisting of the 1st, 2nd and
3rd Canadian Divisions. The 1st Anzac Corps, after a tem-
porary withdrawal from the Somme area, came back to it at
the beginning of November and took up a sector on the Fourth
Army front.

On the 13th November General Gough's army launched an
attack on the Ancre at St. Pierre Divion and Beaumont Hamei.
Both positions were captured. When the battles of the Somme
and Ancre ceased on the 17th November the line held was
thus advanced from north of Thiepval across the Ancre just
west of Grandcourt to the north of Beaucourt-sur-Ancre and
thence to the original line south-west of Serre.

In this succession of battles divisions from all sectors of the
British front took part ; exhausted divisions were withdrawn
to a reserve corps in rest areas behind the battle front, or to
quiet areas on other fronts. Fresh divisions took their place,
and an incessant change and interchange of formations went
on throughout the whole period.

The several advances are shown on the map, and the fierce
character of the attacks and the more or less quiet periods
between them are well illustrated in the chart (page 51)
showing the number of the wounded who were received into
the field ambulances dav by day between the 1st July and
the 26th November 1916.

The diagrammatic charts also indicate the constant change
and interchange of divisions in the various corps engaged and
the comparative shortness of the time they were in the fighting
line before being withdrawn, a factor which materially affected
the medical and sanitary services.

CHART SHOWING MOVEMENTS OF CORPS AND DIVISIONS DURING
THE BATTLE OF THE S0MME./9/6.

FOUR

LT *i a_ rmv

UNIT

JULY

AUfi.

sep*;

OCT.

NQV-

DEC.

jj)M CORPS
8* Div.

-2

12* Div.

-4

19* Div.

• 3

£3'* Div.

— /2

/2— —

i— IO

I st Div.

i2 3/

/5* Div.
50 th Div.

5——
/7

47* Div.

24—

— 12.

*■ Div.

7 !

£»» CORPS

■ 6

4 th Div.

— 6

29* D'V.

-6

3/" Div

48*pjv.

-6

3 *6L

X • "0* *"

II { |

■« g '" 2

.2 o g .2

Ji • §•!

0.53-0
^• B 3 fe

"lis

.? ri s

E u 3' xi

§ C * O

■o *" .r £

1. a,

X J X i_>

h 1-

L
O

—

25* Div.

32"'piv.

■■6

S6* Div-

■ (

49* Div.

■m6

12* Div.

4--

7* Div.

8— 1»7

15* Div.

-4

5* Div.

1 2?

28-

35-* Div.

5—'/

2 htt I.Cdv.Dtv.

47* Div.

f< 23

lZmmm/9

2"« Div.

/3— » ie

34* Div

1 8- 20

20* Div.

>9»20

20—24

55 "'Div.

.'-;

30 1

• 2

J"" NZ. Div.

20—

»3

6 — 10

4/ st Div.

n«-i

—•7

/6— 20

56* Div.

24— -

■•4

/O 24

6* Div.

2ft a

— 7

/4 th Div.

30«

—a/1

24* Div.

7 20

4* Div.

17—24

/ 6* Div.

/9«20

3Q* Div.

2(— ■

-4

l«-|.Cav.Div.

29*

/ ,r Div.

2.1* Div.

3-7

23-* Div.

;»— »4

fl*> Div.

J4-/6

13* CORPS

BMDH/b

9*Div.

;$*Piv.

30* Div.

3'* Div.

— /6

35* Div

J3i

-«tt-/6

/ tr Cav. Div

/3— 23

2^I.Cav.Div

/3«— i -23

2"" Div.

20 i ■

— J2

55* Div.

25—

— — /6

24* pi v.
/4* 1 CORPS

3/<

3"* Div.

/7— 22

24 rt D»v.

/7— 24

35* Div

; 7»iiimb '

55* Div

/7«/8

20* Div

21 —

— — — /<*

5* Div

25—

Guards Div.

26—

16* Div.

30«

■—■17

56* Div

— i2

6* Div.

3— —

—24

4* Div
2 h *Cav. Div

25—

L9
— 8

8* Div
33 rd Dtv.

;9—

i>9
— 8

/7* Div
29* Div.

13 2S48C 506 O

/ lf-1.1500. II. 23

H M.S.O., Ci

CHART SHOWING MOVEMENTS OF CORPS AND DIVISIONS DURING
THE BATTLE. OF THE SOMME.. ISW6 ■ CONTINUED.

FOURTH ARMY CONTiNUED

2S£

UNIT

AUG.

AlfLTi

tyc CORPS

y^Div.

•22

/yfrpiv.

^9 23 =

-/4

2M c Dt

4//— (9

-8

Div.

5-/2.

rA Q-.y.Div

Ti>

^roivA

J&!

[£

5 tn 0rv.

■24

^Div.

2Q;

SO )2.— .11

)4* Div.

13-

24 th Div.

2ff"

*$*P'v

.31

4j£Di

]» c N.2.D»v.

aa pi*.

3£

.22

K)*Div.

:££

>9*Di

^I.Gxv.Div.

24-

lUgrdsDiv

24.

P c Div.

24-

20^ Div

2-4-

J4_

1£

24»25

4* Div.

60^ Div.

>23

6*D.

20'

40* Div.

/^ANZ AC CORPS

K»I6

f^Aus Div

a^Aua.Jiv

<i—*)8

20-

4**^* Div

J2=iflL

26:

5»Attft.Div.

<4-<8

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/7-

Wcorps

I7«*D

2l >c Div.

/6— 22

20*2/

J£

7*Div.

22*23

9* Div.

23-26

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/S^Div.

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CAVALRY CORre

!" $&$*.

?11>vDiv

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'2 5

> f >.Cav.Div.

IS-

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« CORPS

I3«

a^coRps

7f^H

ga^Div

36^ Div.

-4)3»)4

fc±

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f st Cav.Div .

3 r * Gov. Div.

6-9

J2_

<»Div.

6-9

Div.

*DT

iO— AS-

RESERVE CFiFTH) ARMY

UNIT

8^ CORPS

2.9* Div.

3>'*Div.

S^Div.

12* Div.

38* Div.

•ggfrQlvT

10"; CORPS

a s ', Div

32"«Div.

36* Div.
49* pi v.

JULY

6-9

/0-

.24

22-25

?23

^15_

6-9

^23

SEPT.

■5 1

•- ^-

-c

-r(

* *>

•j

■n

•l

3 c

•)

"* h

ifl

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to
a

c d

ft-'

C jj

in
ft)

S £

-J— i

ft)

-C

j_>

/Z^ Div

6— <0

^g 01 Piv

10-12.

ffl&

13 . 28*8 C . SOSO/ 141 1500 II . 23.

H.M.SO. Cr

CHART SHOWING MOVEMENTS OF CORPS AND DIVISIONS DURING

" the: rattle of the somme 1916 continued

RESERVE (FIFTH) ARMY C0NTINUE.O.

7"PT

AUG.

He5

OCT.

TTovT

HSZ

lav. Div,

i"/\ut.mv.

Jfi-

2"*Aus.DivT

--3

4*Aus D'tv.
2»* C6RPS

725^0

24«

■20

» Div.

24—

£010

di.

9» Div.

24«

T25

as"* Div.

/0 25-

H* Div.

«/8

-2 7

/3°? Pi*

/0«

QQ; Dtv.

•77

17'

•M

Div.

72?

■/5"

Cdn.Div

ia-

3 7

30"

JiLPJv

(7S

2»« Div-

as** Div.

»* W^

M g Div.

—7

48™ Div

-2

[3T

'* Cav. Div.

TVS-

14* CORPS

i*.

Div.

>/6

i»Div.

•75

Gtiorda Div,

6» Div.

5*" CORPS

.16

Guards Div.

16—22

20 th Div.

-20

2~LDi

39 » Div.
48^DJy.

19'

24'

78"

.££

3"» Pi
5f» c Pi

!l£.

;sr

_JtV

37°* Div

22-

i)3

n^oiv.

<4— 18

lEvL

(3-

2I<

raw

PIP

255

"25*

161

IB-

'12.

2a— 2 7

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19"* Div.

/9«

lL6_

3l' r Div.

40* Div.

7 W L

J5--I8

/« r G£Tuiv.

120

28-

3 rJ Cdn.Div

4 tK C<in.Div
4* CORPS

(0«

n<* Div.

J^CnvDiv

20-

25** Div.

22— il

» Div.
^Div.

J4_

7#*

-Di\6_

24^

Div.

■23

51* Div
61 st Div.

"The columns indicate, the, period during which corps were in

the, army and divisions in the corps.
The figures against the columns indicate the day of the month

the corps or division entered or lejt the army or corps.

f3.m8C 506O//4I . l50O.ll.ei

H Ml SO.Cr

THE SOMME BATTLES OF 1916

The Work of the Medical Services.

It would not be possible within the limits of space to enter
into the details of the work of the medical services of each of
the divisions. The positions occupied by regimental aid posts,
advanced and main dressing stations of one division were handed
over to the medical services of the relieving division, and the
general situation, as regards divisional medical services, was
thus common to all. The regimental and divisional arrange-
ments differed but little from those already detailed in con-
nexion with the battles of 1915, except in so far that the aid posts
and advanced dressing stations became more and more elaborate
in construction, in the amount of their accommodation and in

Entrance to a regimental aid post near Courcelette.
Ruins of the "Re. I Chateau."

the shelter provided, and that greater use than ever was made
of tram lines or light field railways or other means of saving
hand carriage by the stretcher bearers for bringing back the
wounded from aid posts to advanced dressing stations. The
collection and evacuation of wounded followed the general
principles laid down in the R.A.M.C. Training Manual and in
Field Service Regulations, but the details of the system had
been perfected and developed as a result of the experience
gained in the battles of 1915. The main interest lies in the
general arrangements that were made for collecting and clearing
from the divisions the large numbers of wounded who came
under the charge of the medical services.

The arrangements may best be described by considering
each echelon of work separately.

16 .MEDICAL HISTORY OF THE WAR

Regimental Medical Service.

The regimental medical service had no new elements intro-
duced into it other than those referred to in previous battles.
As a rule the number of battalion stretcher bearers was increased
from 16 to 32, and trench stretchers had been authorized in
addition to the field stretchers. Regimental aid posts were
invariably in dugouts or in sheltered positions in the communi-
cation trenches, or in cellars of village houses, many of which
had been more or less damaged by shell-fire. As a rule the
wounded were brought back down communication trenches

L, «r^

if wM

-■*'

Hr ^i

Bringing in a wounded Prussian artillery officer at Contalmaison.
Battle of the Somme 1916.

specially allotted for their evacuation, but in many instances
these had been damaged and obstructed by shell-fire, and the
use of wheeled stretcher carriers for bringing back the wounded
above ground was then found of special value. As the line
advanced many excellently constructed aid posts were found
in the enemy's trenches and used as regimental aid posts and
advanced dressing stations in succession.

Field Ambulances.

The work of the bearer divisions of the field ambulances
was greatly facilitated in some areas by the use of light field
railways or trolley lines, and also by wheeled stretcher carriers.
Enemy prisoners of war, in their transit to the rear from the

THE SOMME BATTLES OF 1916

positions where they were captured, helped to a considerable
extent to carry wounded back. The stretchers were replenished
by the system adopted in the battle of Loos, that is to say they
were sent up to the field ambulances by the motor ambulance
convoys from dumps maintained at the casualty clearing
stations.

With regard to the positions of advanced dressing stations,
main dressing stations, and walking wounded collecting posts,
the factor which chiefly dominated the arrangements was the
width of the front occupied by divisions and corps. Some of
these fronts were exceptionally narrow — for example, the front

Entrance to the advanced dressing station at Bouzincourt.
Battle of the Somme 1916.

occupied by the XHIth Corps on the 1st July with two divisions
in line had a width of about one and a half miles only, and
that of the Illrd and Xth Corps about two miles. The XVth
Corps had a wider front, while the VTIIth Corps, which had
three divisions in line, had a front of about four miles. Conse-
quently, in preparing for the battle, the XHIth Corps with its
narrow front arranged to have only one advanced dressing
station, one walking wounded collecting station, and one
main dressing station for the corps, these posts being formed
by the field ambulances of the divisions engaged. The advanced
dressing station of this corps was at farms on the road between
Bray and Maricourt ; the collecting post for walking wounded
being further down the road and just north of Bray ; the

MEDICAL HISTORY OF THE WAR

corps main dressing station was just south of the road between
Bray and Corbie, near the cross roads between Treux on the
Ancre and Sailly Laurette on the Somme. This latter position
was known as Dive's Copse* and became an important corps
main dressing station during the greater part of the operations.

Interior of advanced dressing station at. Bouzincourt.
Battle of the Somme 1916.

The other corps of the Fourth Army at the beginning of the
operations retained, to a certain extent, the divisional organiza-
tion of advanced dressing stations and main dressing stations.
But the advantages of establishing one large corps unit instead
of divisional units, when divisions were operating within a
corps on a narrow front, were so well brought out during the

* Named after Captain Dive, R.A.M.C., No. 96 Field Ambulance, who
was the first officer in command of this main dressing station.

THE SOMME BATTLES OF 1916

work of the medical services in the XHIth Corps in the first
phase of the battle, that the Fourth Army adopted the system
for all its corps, and the Director-General for Medical Services
emphasized this in a memorandum of the 25th July 1916, in
which he issued an instruction to Ds.M.S. of Armies that when
corps were operating on a narrow front the work of the main
dressing stations should be concentrated, as far as possible,
at some suitable central place in the corps area, and, in order
to maintain continuity of command and organization, the
commanding officer of one of the field ambulances, with the
quartermaster, serjeant-major, and a clerk, should remain in

Field ambulance at Red Cottage, Fricourt. Battle of the Somme 1916.

charge and not be changed so long as his field ambulance
remained in the corps, although it might be withdrawn with its
division to some other position in the area.

Consequently the corps main dressing stations in the latter
part of July were at Dive's Copse for the XHIth, on the right
bank of the Ancre, between Buire and Dernancourt, for the
XVth, and at Albert for the Illrd Corps. They remained in
that position during August, with the exception of the main
dressing station of the Illrd Corps, which, with its walking
wounded collecting post, had to be withdrawn from Albert
to the neighbourhood of Lavieville. In the middle of Sep-
tember Dive's Copse was closed as a main dressing station
position and moved forward to the Brav-Maricourt road, and

20 MEDICAL HISTORY OF THE WAR

the main dressing station of the XVth Corps was transferred
to Becordel-Becourt, between Fricourt and Albert.
* The positions of the main dressing stations of the XVth
Corps at the beginning of the battle on the 1st July were at
Morlincourt and Mericourt TAbbe. and of the Illrd Corps at
Lavieville, Millencourt and Henencourt. The main dressing
stations of the Xth Corps were at Warloy and Force ville, and
of the Vlllth Corps at Bertrancourt, Louvencourt, Bus les
Artois and Couin.

Advanced operating centres were established by field ambu-
lances of the Xth Corps in Warloy and of the Vlllth Corps in

Advanced dressing station of a field ambulance in a shell hole at Fricourt.
Battle of the Somme 1916.

Authie, with special surgical teams for the purpose of immediate
operations on abdominal wounds and other injuries. The
surgical and nursing staffs of these operating centres, however,
were not moved with the field ambulance to which they were
attached for administrative purposes. In the case of the
advanced operating centre at Authie, it was later on con-
sidered desirable to place it for administrative control under
a casualty clearing station instead of under a field ambulance.
During July as many as three operating surgeons and nine
nursing sisters were on duty at the operating centre in Warloy.
It occupied a small but well-built civil hospital with 75 beds,
supplemented by accommodation for 375 other wounded in
tents, huts and other buildings. It was taken over by the

THE SOMME BATTLES OF 1916 21

medical services of the Unci Corps on the 24th July from the
Xth Corps ; and on the 1st August a detachment of a casualty
clearing station (2/ 1st South Midland) was placed in charge
of it by the D.M.S., Reserve Army.

The lying down wounded and more severely wounded amongst
the sitting-up cases were received into the main dressing
stations, with the exception of those that were sent direct
by advanced dressing stations to these advanced operating
centres, but with regard to the lightly wounded, some special
arrangements were made previous to the battle throughout
the whole of the Fourth Army area with the object of utilizing
certain lines of railway for conveying them to the casualty

Field ambulance cars near Fricourt. Battle of the Somme 1916.

clearing stations. One broad-gauge strategical line had been
constructed from Vecquemont on the main line between
Longeau and Albert northwards through Frechencourt to
Contay, and another from Candas on the Doullens-Amiens
line eastwards through Puchevillers and Clairfaye to Acheux.
A narrow-gauge railway ran from Gezaincourt, one of the
stations on the Doullens-Amiens line of railway, through
Beauval to Acheux and onwards to Albert.

Consequently, in order to utilize these lines of railway for
lightly wounded, the Illrd Corps established a large collecting
post and rest station for lightly wounded at Frechencourt,
where they were entrained for the CCS. at Vecquemont ;
the Xth Corps a similar post at Vadencourt, near Contay,

The collecting post of a field ambulance at Auction villers
before protection by sandbags.

The same collecting post in process of being protected by sandbags.

The same collecting post after protection by sandbags.

THE SOMME BATTLES OF 1916

and at Clairfaye, where walking wounded were collected for
entraining at Acheux ; and the VHIth Corps one at Acheux.

In the later phases of the battles a broad-gauge strategical
railway, which had been constructed from Dernancourt to
Maricourt, was also used for clearing lightly wounded from
corps collecting posts that had been formed in the neighbour-
hood of Carnoy and Maricourt.

When the front of the Fourth Army, owing to the area north
of Albert having been taken over by the Reserve Army on

The collecting post at Auchonvillers
after being shelled.

the 6th July., was contracted approximately from Contal-
maison to a line facing Guillemont and Trones Wood,
a distance of between four and five miles, the three
corps occupying that front at the time, namely, the XlVth,
XVth and Illrd, had their walking wounded collecting posts
respectively at Bronfay Farm on the Bray-Maricourt road,
at Becordel-Becourt, and at Albert. The Illrd Corps
retained their slightly wounded collecting station at Frechen-
court, and the Reserve Army similar stations at Vadencourt,
Clairfaye and Acheux. The walking wounded collecting post

MEDICAL HISTORY OF THE WAR

at. Albert, however, became unsafe on account of enemy shell-
tire, and was withdrawn to a position near Lavieville on the
Albert road.

Road from Fricourt to Contalmaison. Battle of the Somme 1916.

Hnr 1 i

1 £?'** Hi

( \h

C*^ , f) .t> -

pHBTft^-' ^te ^TB^BBftlfir 11 '

' : .. . ■ ,

. ,:

Advanced dressing station at Contalmaison. Battle of the Somme 1916.

By the middle of September the walking wounded collecting
station of the Illrd Corps was advanced to Fricourt, and that
of the XlVth Corps to the neighbourhood of Carnoy. The Illrd

THE SOMME BATTLES OF 1916

Corps then closed its lightly wounded collecting station at
Frechencourt, but was again obliged to withdraw the post at
Fricourt to Lavieville.

The collection of wounded by the field ambulances from the
regimental aid posts to their advanced dressing stations was
either by hand carriage, on wheeled stretchers, or on trolley
lines, but occasionally horsed wagons and motor ambulance
cars were able to go by night to some of the aid posts or to
their neighbourhood. In some instances all these methods of
carrying wounded back were employed on one line of evacua-
tion ; for example, in the fighting around Courcelette, wounded

"Armoured" motor ambulance car at Fricourt.
Battle of the Somme 1916.

were carried part of the way on trolley lines to the Albert-
Bapaume road at Pozieres, and transferred there to horsed
wagons or ambulance wagons, or carried further down the
valley towards Contalmaison by trolley lines or hand carriage.
The work of the bearers in this particular sector was especially
heavy, as in places they had to carry the wounded a distance
of some 2,000 yards before being able to place them either on
wheeled vehicles or on trolley lines. From the advanced
dressing stations to the lightly wounded collecting posts the
horsed wagons of the field ambulances, or lorries and chara-
bancs, and in some cases trolley lines, were used, but consider-
able use was also made of the newly constructed strategical
railways, especially for bringing back the lightly wounded from

26 MEDICAL HISTORY OF THE WAR

the walking wounded collecting posts near Carnoy, Vadencourt
and Frechencourt to the casualty clearing stations. From
Clairfaye and Acheux in the northern area the narrow-gauge
railway was used.

The ground over which the advance had been made had
become impossible for wheeled traffic or new tramway lines
during the latter part of October and beginning of November,
and the stretcher bearers were then reinforced in some corps,
notably the XlVth, by men obtained from Pioneer battalions
and from the divisional trains. Up till then the supply of
stretcher bearers was adequate so long as the weather continued

" Armoured " motor ambulance car bstween Fricourt and Contalmaison.
Battle of the Somme 1916.

fine. In arranging the relays between Gueudecourt and
Longueval, the average carry for each relay was 1,000
yards, and as a rule three relays were required to bring men
back to the tramway lines. The time taken depended much
upon the weight of the patient, the strength of the bearers,
the state of the track as regards mud, and the presence or
absence of barrage fire.

The motor ambulance transport of the field ambulances was
mainly employed in conveying the seriously wounded and lying
down cases from the advanced dressing stations to the main
dressing stations, and also direct from the advanced dressing
stations to the advanced operating centres or to those casualty
clearing stations allotted for the reception of urgent cases.

THE SOMME BATTLES OF 1916

o -P

Casualty Clearing Stations.

Sites for casualty clearing stations had been selected and
prepared previous to the battle close to the broad-gauge
railway lines, so that ambulance trains could come up direct
to the casualty clearing stations and evacuate them without
using cars from the motor ambulance convoys.

MEDICAL HISTORY OF THE WAR

Two or more casualty clearing stations were grouped on these
sites, but carried on their work as independent units, the

wounded being brought to them in rotation, so that each
casualty clearing station had only a limited number of wounded,
varying from 150 to 300, admitted to it at one time. This

THE SOMME BATTLES OF 1916 29

enabled the surgical work to be carried on more thoroughly
and in a more leisurely way than would otherwise have been
the case, and also gave the officer in charge and the rest of
his staff an opportunity of having the particulars of each case
recorded, and proper arrangements made for entraining them
on the ambulance trains.

At first the number of casualty clearing stations in the
Fourth Army permitted of their being grouped in twos only ;
thus, in the southern part of the area the positions selected
were along the Amiens-Albert line of railway, namely, at
Heilly, where Nos. 36 and 38 C.C.Ss. were established, at
Corbie and La Neuville, a suburb of Corbie, for Nos. 5 and
21 C.C.Ss., and at Vecquemont, near the junction of the newly
constructed broad-gauge railway to Contay, where Nos. 34 and
45 C.C.Ss. were established.

As ambulance trains were not permitted to run at this time
on the broad-gauge railway to Contay, no casualty clearing
stations were established in this central position, although it
was a very desirable and convenient locality for one or more
casualty clearing stations. In the northern sector two casualty
clearing stations were established at Puchevillers (Nos. 3 and
44), and two in the Citadel at Doullens (Nos. 35 and 11).

There were single casualty clearing stations at the commence-
ment of the battle at Gezaincourt (No. 29),* Beauval (No. 4),
St. Ouen (No. 39) and Amiens (1/lst South Midland).

All of the casualty clearing stations, with the exception of
those in the Citadel at Doullens, at Beauval and at Amiens,
could be cleared direct to ambulance trains without the inter-
vention of motor transport. No ambulance trains were per-
mitted to load at the railway station at Amiens, although the
casualty clearing station there was only one or two hundred
yards from the railway station. The patients in it had to be
taken by ambulance car for entraining to Longeau, some three
miles distant. From Beauval and the Citadel at Doullens
they were entrained at Gezaincourt, but subsequently arrange-
ments were made with the Third Army to have the patients in
the Citadel taken to Doullens railway station for entraining.
Doullens railway station was some distance from the casualty
clearing stations and motor ambulance cars or other transport
were required to bring the wounded to the trains ; but at this

* An officers' hospital was opened in a large chateau at Gezaincourt ,
to which a special staff of medical officers and nursing sisters was appointed.
It was under the administrative charge at first of No. 29 C.C.S., but after
wards of one or other of the casualty clearing stations at Gezaincourt.

(10134) D

MEDICAL HISTORY OF THE WAR

station an excellent refreshment buffet had been established
by Miss Boot, with the sanction of the French military
authorities, at the time when Doullens was in the French
armv area. Miss Boot was permitted to carry on this work
afterwards when the British took over the area, and was conse-
quently able to do much for the sick and wounded when they
arrived at the station pending entraining.

For Indian troops an Indian cavalry field ambulance was
opened at the beginning of the operations at Vecquemont,
but this was replaced very soon by a section of the Lucknow
Casualty Clearing Station.

W- 1 "^ st

\ i -

g« mmfgf. •*.$$ ^mt-. ^?

: I

;<' < ?'!

■;.■■;.<

\*'

Wtm$

In a casualty clearing station behind the Somme Front 1916.

The Third Army had two casualty clearing stations in the
town of Doullens, Nos. 19 and 41. In preparation for the
battle, the Third Army had also prepared a new site for casualty
clearing stations on the Doullens-Arras road at a chateau
and in fields near Solerneau, and close to the railway line at
the halte for Warlincourt. Two casualty clearing stations were
placed there, Nos. 20 and 43, and to these casualty clearing
stations, and to the casualty clearing stations at Doullens, the
casualties in the attack on Gommecourt Salient were taken.
In addition to casualty clearing stations in other parts of the
Third Army area there were stationary hospitals in extensive
and well-constructed French hospital huts that had been only
recently erected at Frevent and St. Pol.

BATTLE OF THE SOMME

SITUATION OF MEDICAL UNITS
4- TH ARMY ON l s r JULY 1916 .

2 3 4-5

SCALE OF MILES ' '

+ ftegi mental^ id Post.

oil

Walking Wounded Collecting Station.

2{&z c t^gPo%r'^ stat ' on or
Walking Wo-
Q Main Dressing Station

Advanced Operative Centre
Casualty Clearing Station

lby& Sons Li

THE SOMME BATTLES OF 1916 31

There were three casualty clearing stations parked in reserve
at Etaples, and one of them, No. 47, was brought up to Hesdin
in the G.H.Q. area during the last week of June in preparation
for the battle. It was under the direct control of the D.G.M.S.
It was established in tents on the parade ground there as an
intermediate post between the front and the Etaples base, in
the event of its being necessary to send wounded to the base by
road from casualty clearing stations in the northern area of
fighting.

The casualty clearing station at St. Ouen, No. 39, was far
back, but was retained there for sick and infectious cases.
Similar arrangements were made in meadows some three
miles west of Doullens at Recmenil Farm, which at the
beginning of the battle was occupied by a field ambulance ;
but on the 6th July a casualty clearing station, the 2/ 1st South
Midland, was brought up from those in reserve on the L. of C.
and took over the site.

Reinforcements. — Immediately after the first attack the need
of additional casualty clearing stations in the area of the
Fourth and Reserve Armies became apparent, especially at
Gezaincourt, which, from the very first day of the battle,
was flooded with the large number of lightly wounded that
were brought back to it by the narrow-gauge railway from
Acheux. Consequently, No. 49 CCS. was hurriedly sent
there from the L. of C. without its equipment, in order that
its personnel might assist in the work of No. 29 CCS. The
personnel arrived on the 3rd July, and the remainder of the
unit was ordered up on the 6th July. On the 13th July the
1/lst South Midland CCS. was moved from Amiens to Vecque-
mont, its place being taken by the New Zealand Stationary
Hospital which had arrived in France from Egypt, and, on
the 6th July, the 2/2nd London CCS. was also brought up
from the L. of C to Heilly. After the first week of July,
therefore, there was a group of three casualty clearing stations
at Heilly and at Vecquemont.

The situation of the casualty clearing stations and their
number were not altered until August, when it was decided to
establish casualty clearing stations at Contay, as permission
had then been received for ambulance trains to run on
the Contay- Vecquemont line. Consequently, No. 49 CCS.
was moved on the 12th August from Gezaincourt to
Contay, and later on No. 9 CCS., on the 14th September,
was also transferred there from the First Army. No. 49
CCS. was replaced at Gezaincourt by No. 11 CCS. from the

32 MEDICAL HISTORY OF THE WAR

Citadel at Doullens, and at the end of July No. 39 CCS. was
brought up from St. Ouen to Allonville, between Amiens and the
headquarters of the Fourth Army at Ouerrieu, where it continued
to be the unit for the reception of sick and infectious cases.

In September and October a general advance of casualty
clearing stations was effected. A site had been selected by
the side of the new strategical railway line on the plateau
between Maricourt and Dernancourt, to which the name of
Grovetown was given. Three casualty clearing stations, the
2nd London from Heilly, No. 34 from Vecquemont, and No. 48
from the L. of C were brought up there between the 10th

No. 45 Casualty Clearing Station at Edgehill, behind the Somme Front.

and 12th September. A similar site near the Amiens-Albert
railway line, north of Dernancourt, to which the name of
Edgehill was given, also became a new casualty clearing
station position, and No. 45 and the 1/lst South Midland
Casualty Clearing Stations were brought up to it from Vecque-
mont, and also No. 13 CCS. from the L. of C The casualty
clearing station centre at Vecquemont was thus closed by the
middle of September. In October No. 5 CCS. at Corbie
was moved to Albert, where, however, it was exposed to hostile
artillery fire. It was moved to the neighbourhood of Bray
to a newly constructed French evacuation hospital.

In the Reserve Army area a new site for three casualty
clearing stations was selected near the broad-gauge strategical

BATTLE OF THE SOMME

SITUATION OF MEDICAL UNITS OF4- T . H &5 T . H ARMIES ON NOVEMBER 30 th 1916.

5 _2 !f

SCALE OF MILES
.2 £__± 2 §_

+ Reqi mental Aid Post. +

£Adv.Dressing Station or Collecting Post €? Casualty Clearing Station

Walking Wounded Collecting Station. \

£3 Main Pressing Station.

S» Stationary Hospital

Divisional Pest Station.
Q Advanced Depot Med Strs.
Motor Ambulance Convoy.

British Front Line
-— French Front Line.
Army Boundaries

Malby'iSor.s.Lith

THE SOMME BATTLES OF 1916 33

railway at Varennes, south of Acheux, and in the neighbour-
hood of Clairfaye. No. 4 CCS. from Beauval and No. 11
CCS. from Gezaincourt were brought up to it early in October,
No. 4 CCS. being replaced at Beauval by No. 47 CCS. from
Hesdin, and No. 11 CCS. by No. 3 Australian CCS. from the
L. of C Later on, in December, Beauval was abandoned
altogether, and its casualty clearing station, too, was brought
up to Varennes. In November, No. 35 CCS., from the
Citadel at Doullens, which remained as the one medical unit
there, left the Western for the Macedonian front, and the whole
of the accommodation in the Citadel was then taken over on
the 13th of the month by No. 3 (Canadian) Stationary Hospital.
Consequently, when the operations on the Somme front
ceased, the casualty clearing station situation in the Fourth
and Fifth Armies was as follows : —

Fourth Army —

At Grovetown . . Three casualty clearing stations.

At Edgehill . . . . Three ,,

At Heilly . . . . Two

At Albert . . . . One ,, ,, station.

At Corbie . . . . One

At Allonville . . . . One casualty clearing station for

infectious diseases and other cases
not requiring evacuation.

At Amiens . . . . One stationary hospital.

Fifth Army —

At Varennes . . Three casualty clearing stations.

At Contay . . . . Two

At Puchevillers . . Two

At Gezaincourt . . Two

At Recmenil Farm . . One ,, ,, station.

At Doullens . . . . One stationary hospital.

No. 19 CCS., in the town of Doullens, had also been placed
at the disposal of the Reserve Army for the operations on
the Ancre in November, but was under the administrative
control of the Third Army.

Accommodation and Equipment. — Exclusive of the accommo-
dation for sick and infectious cases at the casualty clearing
station at St. Ouen and, afterwards, at Allonville, the casualty
clearing stations of the Fourth Army in July could accommodate
9,500 wounded, namely, 2,200 at Heilly, 1,550 at Corbie,
1,600 at Vecquemont, 1,800 at Puchevillers, 1,000 at Gezain-
court, 400 at Amiens, 450 at Beauval, and 500 in the Citadel
at Doullens.

34 MEDICAL HISTORY OF THE WAR

In order to provide for the additional work at the casualty
clearing stations, an enormous amount of equipment was added
not only for medical and surgical purposes, but also in order
to provide well equipped beds and hospital comforts for the
more seriously wounded, and better shelter and accommodation.
Officers commanding casualty clearing stations indented very
extensively on ordnance stores for additional equipment, and
the Joint Committee of the B.R.C.S. and Order of St. John,
which had an advanced store at Recmenil Farm, materially
assisted in adding to the comfort of the casualty clearingstations.

Operating theatre in portable hut of a casualty clearing station
behind the Somme Front.

Some idea of the extent to which casualty clearing stations
expanded in this way may be gathered from the fact that,
when the transfer of casualty clearing stations from Vecque-
mont to Edgehill and Grovetown took place, the number of
lorries required to move each of them varied from fifty to
one hundred. Thus, No. 45 CCS. in moving to Vecquemont
had one hundred lorry loads of equipment and material. The
equipment alone amounted to 150 tons, not including some
huts which had been erected at Vecquemont * When a
casualty clearing station was moved by rail, generally a whole

* Twenty of the lorries carried road metal for making roads. This casualty
clearing station had constructed paths and roads at its site in Vecquemont,
and took the material up in order to construct similar roads in its new site
at Edgehill.

THE SOMME BATTLES OF 1916

train was required to carry it. As the tonnage of a casualty
clearing station according to War Establishments is only
twenty-three tons, capable of being carried on eight 3-ton
lorries, some idea may be formed of the unwieldy nature of
casualty clearing stations during this period. Nevertheless
there was little or no delay in moving them, provided lorries
and trains were available for the purpose.

Personnel. — The personnel of casualty clearing stations
had not been altered from the original War Establishments,
with the exception of the addition of nursing sisters and dentists.

Australian wounded being brought to a casualty clearing station.
Battle of the Somme 1916.

but it was obvious that with the great increase in the accommo-
dation of the casualty clearing stations, additional personnel
would be necessary. These were obtained at first from field
ambulances of the reserve divisions of corps, each corps providing
two parties of three officers, three N.C.Os. and twenty men.
Each of the casualty clearing stations was reinforced by one
of these parties. In addition, the VHIth and Xth Corps
detailed two medical officers, two N.C.Os. and eighteen other
ranks for duty, under the O.C., No. 29 C.C.S., on the trains
running on the narrow-gauge railway between Acheux and
Gezaincourt. Each corps had also to detail one officer and
fifty men temporarily unfit or permanently unfit for duty in
the fighting line to each of the casualty clearing stations for
fatigue work and for loading and unloading ambulance cars
and ambulance trains.

36 MEDICAL HISTORY OF THE WAR

At the commencement of the battles of the Somme, Surg.-
General Sir Anthony Bowlby was stationed at No. 38 CCS.,
Heilly, and acted as consulting surgeon for the group of casualty
clearing stations in the southern area of the Fourth Army,
while the consulting surgeon of the Army, Colonel T. Sinclair,
was stationed at No. 3 CCS. at Puchevillers as consulting
surgeon for the group of casualty clearing stations in the
northern area. Colonel Sir Wilmot Herringham also went
from G.H.Q. to No. 36 CCS., Heilly, as a consulting physician
in connexion with wounds of the chest. Sir Anthony Bowlby
returned to G.H.Q. on the 23rd July, and Colonel Sinclair
then rejoined the Fourth Army Headquarters at Querrieu.
On the 30th August Colonel Maynard-Smith was appointed
consulting surgeon to the Reserve Army, but until he took
up his duties Sir Anthony Bowlby acted as consulting surgeon
to the Army, supervising the surgical work in it from G.H.Q.

In anticipation of the fighting in the Fifth Army on the
13th November, Colonel C Wallace, consulting surgeon of
the First Army, was temporarily attached to the casualty
clearing stations at Puchevillers and Contay, and Colonel
Maynard-Smith to those at Varennes.

Considerable additions were also made to the personnel
of the casualty clearing stations immediately after the initial
attack. The D.G.M.S. arranged on the 3rd July for the D.M.S.,
L. of C, to send fifty emergency stretcher bearers from the
R.A.M.C Reserve Bearer Company at Boulogne to No. 36
CCS., fifty to No. 34 at Vecquemont, and forty R.A.M.C
other ranks from No. 29 Field Ambulance, which was then in
reserve on the L. of C, to No. 3 CCS., followed by twenty
nursing orderlies of the same field ambulance to each of the
casualty clearing stations at Heilly.

A number of surgical teams, each consisting of one specialist
surgeon, one anaesthetist, one nursing sister and one operating
room attendant, was sent from the First and Second Armies.
On the 2nd July two of these teams were sent to Vecquemont,
two to Heilly, one to Amiens, two to Puchevillers and two to
Corbie. On the 17th July a still further reinforcement of
surgeons was obtained from casualty clearing stations in the
Third Army, namely, two for No. 23 CCS., two for No. 45
CCS. at Vecquemont, and two for No. 36 CCS. at Heilly.

The increase in this way of surgical personnel led to a con-
siderable advance in the surgical work performed in casualty
clearing stations.* Casualty clearing stations which were only

* See Chapter XI, Surgery of the War, Vol. I.

THE SOMME BATTLES OF 1916

receiving lightly wounded did not, however, have an addition
to their surgical staff. In others the number of medical officers
was practically doubled.*

A curious incident occurred in No. 21 CCS. at La Neuville,
near Corbie, which is of some historical interest. A N.CO.
of the R.A.M.C on duty with the unit created much excite-
ment by what appeared to be a method discovered by himself
of delineating the internal organs by means of electric currents
passed through the body. His work was studied by consulting
surgeons and others, whom he completely deceived, and notices
appeared in medical journals of this apparently important
advance in medical science. | Later on, during the battle,
he began to produce what appeared to be photographs taken
by wireless methods. His photographs showed enemy aero-
planes and airships travelling over Corbie by night at a time
when a raid was expected. A still further advance in his
activities was made when he announced that he had discovered
a method of destroying life at a distance by electric power.
He was then given every facility for carrying on his experiments,
and eventually he was placed under the direct supervision
of the General Staff and their expert electric advisers, in an
enclosure at No. 12 Stationary Hospital, St. Pol. The final
result was that the whole of his experiments were proved to
be fraudulent. The N.CO. was placed under arrest and tried
by court martial.

Disposal of Casualties. — The distribution of wounded and
sick to the casualty clearing stations was determined by the
D.M.S. of the Army, who issued instructions for the disposal
of the wounded as follows : —

Seriously Wounded.
From Xlllth Corps to No. 21 CCS. Corbie.

No. 45 ,, Vecquemont.

XVth

Illrd

No. 5
No. 34
No. 36
No. 38

Corbie.
Vecquemont.
Heilly.
Heilly.

* On 12th September 1916 the number of medical officers in the Fourth
Army casualty clearing stations was as follows : —

Grovetown — 2 /2nd London CCS. . . . . . . . . . . . . 10

No. 34 CCS 12

No. 48 CCS. (lightly wounded) 7

Edgehill— No. 45 CCS 12

1 /lst South Midland CCS 13

No. 13 CCS. (lightly wounded) 7

Heilly— No. 36 CCS 13

No. 38 CCS 13

t See British Medical Journal, Vol. II, 1916, pp. 459, 468 and 565.

10134 E

38 MEDICAL HISTORY OF THE WAR

From Xth Corps to No. 3 CCS. Puchevillers.

No. 44 „ Puchevillers.

„ Vlllth „ No. 4 „ Beauval.

No. 29 ,, Gezaincourt.

Lightly Wounded.
From XHIth and XVth Corps to CCSs., Heilly.
Illrd Corps to CCSs., Vecquemont.
Xth and Vlllth Corps to CCS., Gezaincourt.

For Urgent Operations {Abdominal Wounds).
From Vlllth Corps to Advanced Operating Centre,
Authie.
,, Illrd and Xth Corps to Advanced Operating

centre, Warloy.
„ XHIth and XVth Corps to CCSs., Heilly.

The casualty clearing stations in each group were filled in
rotation, as already mentioned. The lightly wounded of the
Illrd Corps were collected at Contay and Frechencourt and
sent to Vecquemont in empty trucks on the broad-gauge
railway. Similarly the lightly wounded from the Xth and
Vlllth Corps were collected at Acheux and sent to Gezaincourt
by the narrow-gauge railway.

Motor Ambulance Convoys.

The motor ambulance convoys were employed chiefly for
clearing the seriously wounded. For this purpose a convoy
was attached to each corps ; No. 10, with the XHIth Corps,
was parked at the corps main dressing station at Dive's Copse ;
No. 27, with the XVth Corps, at Heilly ; No. 21, with the Illrd
Corps, at La Houssoye, on the Amiens-Albert road, but moved
in September to the corps main dressing station at Lavieville ;
No. 6, with the Xth Corps, at Toutencourt and afterwards at
Clairfaye ; and No. 20, with the Vlllth Corps, at Beauval, and
afterwards at Bouzincourt, near Albert. An additional motor
ambulance convoy, No. 25, was held under the direct control
of the D.M.S. of the Army at Les Alencons.

This was the distribution of motor ambulance convoys in
the first phase of the battle, but it was found necessary as the
operations progressed to reinforce both the Fourth and
Reserve Armies with fresh convoys. Consequently a convoy,
No. 31, was sent up from the L. of C in the middle of September
to Les Alencons, and took the place there of No. 25, which
was moved forward to Corbie in place of No. 10, transferred

THE SOMME BATTLES OF 1916 39

to the neighbourhood of Bray and Grovetown, and eventually
to Becordel-Fricourt at the beginning of October. No. 25
was also moved to the neighbourhood of Fricourt in November.

In the northern area No. 26 M.A.C., which had been stationed
at St. Omer, was transferred to Beauval after the first week
of July as the reserve convoy under the D.M.S. of the Reserve
Army. It was moved towards the end of August to the neigh-
bourhood of Contay, when Contay became a casualty clearing
station centre.

Towards the end of September No. 6 M.A.C. was becoming
unfit for work, and was consequently moved from its front
area to Beauval, and replaced by a new convoy, No. 30
M.A.C, which had been brought from the L. of C.

When the preparations were being made for the attack on
the Beaumont Hamel position by the Fifth Army, in November,
No. 31 M.A.C. was transferred from the Fourth Army to
Couin in the northern sector of the Fifth Army and attached
to the Xlllth Corps, which was to take chief part in the attack.

When the operations on the Ancre ceased No. 30 M.A.C.
was moved back to Doullens. The final distribution of motor
ambulance convoys to Corps was then adjusted as follows : —

With the Fourth Army —
No. 25 M.A.C. attached to the XlVth Corps at Fricourt.
No. 27 M.A.C. attached to the 1st Anzac Corps at Heilly.
No 21 M.A.C. attached to the Illrd Corps at Lavieville.
No. 20 M.A.C. attached to the XVth Corps at Les Alencons.
No. 10 M.A.C, which had been withdrawn from Fricourt
on the 19th November, was at Corbie.

With the Fifth Army —

No. 26 M.A.C. with the IVth Corps at Bouzencourt.
No. 30 M.A.C. with the Vth Corps at Doullens.
No. 31 M.A.C. with the Xlllth Corps at Authie.
No. 6 M.A.C. at Beauval as Army Reserve convoy.

Use of Lorries, Buses and Light Railways.
For the conveyance of the lightly wounded from the lightly
wounded collecting stations, the lorries of casualty clearing
stations and such other lorries as could be made available
were fitted with seats and used for this purpose ; also a number
of charabancs or buses was placed at the disposal of the
D.M.S. But the chief method of conveyance of the lightly
wounded to casualty clearing stations from all except the Xlllth
and XVth Corps in the earlier phases of the operations was,

(10134) E*

40 MEDICAL HISTORY OF THE WAR

as already noted, by empty supply wagons on the broad-gauge
railway from Contay to Vecquemont, and by the narrow-gauge
railway from Acheux to Gezaincourt. On the former the
empty supply wagons were used, and special arrangements
were made by the casualty clearing stations at Vecquemont
for their reception on arrival there, previous to their being
loaded on to the ambulance trains for conveyance to the base.
In no case were the empty supply trains used for bringing back
wounded to the base, and strict orders were issued to prevent
their being so used without direct instructions from the D.M.S.
of the Army concerned.

Wooden trolly line for bringing wounded from the casualty clearing stations
at Puchevillers to ambulance train siding. Battle of the Somme 1916.

On the narrow-gauge railway between Acheux and Gezaincourt
four trains had been organized, each consisting of eight covered
trucks and three passenger coaches, or nine covered trucks
and two passenger coaches. Each of these trains was organized
to carry on an average 60 lying and 20 sitting cases, and it
was estimated that each train would probably be able to make
four journeys every twenty-four hours. The running of these
trains was to be arranged by the railway transport officer at
Gezaincourt in conjunction with the O.C., No. 29 CCS. The
entraining arrangements at Acheux were under the control
of the D.D.M.S., Vlllth Corps, who appointed an entraining
medical officer. These trains were to be used by both the
Vlllth and Xth Corps, but the whole of the lying down

THE SOMME BATTLES OF 1916

accommodation was reserved for the Vlllth Corps wounded.
The lightly wounded at the collecting stations at Clairfaye
and at Acheux were brought back on this line to the casualty
clearing stations at Gezaincourt, but the trains were also
available for use at any time to evacuate cases from No. 4 CCS.
at Beauval to the ambulance trains at Gezaincourt. Acheux
was frequently shelled by long-range guns, and arrangements
were made to load the trains at a point west of Acheux instead
of at the railway station there.

When the broad-gauge railway had been constructed from
Dernancourt to Maricourt, it was used for bringing back the
lightly wounded from the walking wounded collecting station
near Carnoy to the casualty clearing stations at Grovetown
and Edgehill.

Classification of Casualties for Transport.
A record of the number of stretcher cases, walking cases,
and shell shock cases was kept by the field ambulances of the
2nd and 8th Division. The record of the former division
from 26th July to 11th August is as follows : —

Table showing the proportion of Lying Cases to Walking
Wounded Cases in the 2nd Division from 26th July to
llth August 1916.

Lying

Walking

Shell shock

cases.

wounded.

(wounded).

26th July

6 Lying

5 Walking

27th

289

349

18 „

28th

329

110

44 ,,

29th

150

28 ,,

30th ,

107

141

8 „

31st ,

1st August

10 „

2nd „

6 ,,

3rd

6 „

4th

6 „

5th

6th

—

7th

1 "

8th

9th

1 ','.

1.0th ,

llth

1 ',',

—

tals

1,344

1,100

146 „

355 „

Proportion of lying to walking = 1 -22 : 1 -00, or 54-9 per cent, of the
total cases admitted = lying cases. Shell shock cases had 29-12 per cent,
of the total as lying cases.

42 MEDICAL HISTORY OF THE WAR

The record of the 8th Division is from two field ambulances
only, No. 24 and No. 25, and for the first three days of the
battle. The results were as follows : —

Casualties in the 8th Division — Comparison of Lying and
Walking Cases.

1st to 3rd July 1916.
No. 24 Field Ambulance.

Total admissions = 1,811 : Total evacuations = 1,757

Walking cases . . = 285 = 16-2 per cent.
Stretcher and

sitting cases . . = 1,472 = 83-8
No. 25 Field Ambulance.

Total admissions = 1,245 : Total evacuations = 1,245

Walking cases . . = 551 = 44-2 per cent.

Sitting cases . . = 423 = 33-97

Lying cases .. = 271 =21-7

Total admissions to the two field ambulances . . = 3,056

Total evacuations : walking cases . . . . = 836 = 27-9 per cent.

of total evacuated.

,, ,, lying and sitting .. . . = 2,166 = 72-1 percent.

of total evacuated.

Depots of Medical Stores.

The medical and surgical supplies of the field units and
casualty clearing stations of the Fourth Army were replenished
from No. 14 Advanced Depot of Medical Stores at Corbie,
No. 18 at Puchevillers, and No. 16 at Beauval ; and in the
Third Army from No. 13 at Doullens, and No. 15 at Frevent
at the beginning of the battle. When the Reserve Army
took over the northern area of the Fourth Army, No. 18
Advanced Depot of Medical Stores at Puchevillers had to
supply the units in the northern sector of the latter army,
but subsequently No. 19 Advanced Depot of Medical Stores
was brought up from the L. of C. to the Fourth Army area
on the 7th August, and was opened in Albert. At no time
did these advanced depots of medical stores fail to meet the
requirements of the medical units.

Evacuation from the Casualty Clearing Stations to the Base.

The success of the arrangements described above depended
upon the adequacy of the means available for evacuating the
casualty clearing stations and avoiding congestion of the army
areas with large numbers of wounded.

The wounded were evacuated from the casualty clearing
stations to the base hospitals by ambulance trains, temporary
ambulance trains, barges on the canal, and by motor ambulance
convoys on the roads.

THE SOMME BATTLES OF 1916 43

The general co-ordination of the work of evacuation was
directed by the D.D.G.M.S., who was in close touch with
advanced G.H.Q. at Beauquesne, with the Ds.M.S. of the
armies engaged, and through the D.G.M.S. office at Hesdin
with the D.M.S., L. of C.

Before the battles commenced, the D.M.S. of the Fourth
Army had estimated the number of wounded that could
be dealt with in the army area on any one day as
24,000. His estimate was based on 9,500 being in the casualty
clearing stations, 10,000 in the various field ambulances, and
4,900 on ambulance trains at one time In order to maintain
an evacuation capacity of 4,900 by railway, he required seven
ambulance trains carrying 400 each and three temporary
ambulance trains carrying 700 each. This he regarded as the
minimum number of ambulance trains and temporary ambulance
trains which should come up to the casualty clearing stations
daily. The total number of ambulance trains in France at
the time was 29, of which six were required on the L. of C. for
moving sick and wounded from hospital centres, such as
Etaples, Abbeville and Treport, to the ports of embarkation
for the United Kingdom, so that there were available for army
areas 23 ambulance trains. An additional train arrived from
England and was placed on the line on the 10th July.

Temporary ambulance trains were organized on a new principle.
They were designated " T.A.T." and numbered consecutively
from number 100 upwards. They were made up of passenger
coaches, and were put in commission and given a staff of medical
officers and orderlies from the time they were required until
such time as it became no longer necessary to use them. Their
movements were regulated in the same manner as the permanent
ambulance trains. Each was calculated to carry 1,000 slight
cases sitting up. The number in commission during the battles
was eleven.

In order to provide seven ambulance trains daily for the
Fourth Army area, practically the whole of the 23 available
ambulance trains would have had to run to the Fourth Army
area. To meet this requirement, therefore, the Ds.M.S. of the
First and Second Armies were instructed to evacuate their sick
and the small number of wounded which they were likely to
have, as far as possible, to the hospitals at St. Omer by road.
Arrangements were also made for clearing as many as possible
of the Third Army wounded by road through Hesdin to Etaples,
and also for retaining sick and wounded in the stationary
hospitals at Frevent and St. Pol. It was thought that in this

44 MEDICAL HISTORY OF THE WAR

way a sufficient number of trains would be available for the
Fourth Army area, but the number of temporary ambulance
trains could be increased to any extent required.

The D.D.G.M.S., however, had grave misgivings with
regard to the clearing of casualty clearing stations, especially
in the event of anything occurring to interfere with the running
of the ambulance trains, and consequently prepared a scheme
for evacuation by canal and road. In addition to No. 4
Ambulance Flotilla, which had been organized on the Somme
when the Fourth Army took over the area from the Third Army,
he had No. 3 Ambulance Flotilla transferred from the Aire-
La Bassee Canal to the Somme Canal. As each of these
flotillas consisted of six barges capable of conveying 30 or 32
lying down cases each, there was accommodation for 360 serious
cases in the two flotillas, and arrangements were made to use
them in clearing the casualty clearing stations at Corbie, Vec-
quemont and Amiens, to Abbeville.

The arrangements for evacuation by road were controlled by
the D.D.G.M.S. from advanced G.H.Q. Arrangements had
been made in case of necessity for the casualty clearing stations
in the vicinity of Doullens and in the northern sector of the
battle area to be evacuated by road to Etaples, through
No. 47 Casualty Clearing Station at Hesdin. Further arrange-
ments were made with the D.M.S., L. of C, for 500 sitting
up cases, capable of enduring a three hours' journey by
road, being cleared daily to Abbeville from Gezaincourt,
Doullens, Beauval and Vecquemont on charabancs in case of
necessity. Charabancs or the motor ambulance convoy at
Beauval were also to take casualties to Hesdin, where they
would be first received by No. 47 Casualty Clearing Station
or No. 20 Field Ambulance, and then transferred, if capable
of continuing the journey, to Etaples by No. 1 M.A.C.,
then stationed at Hesdin under G.H.Q. control. No. 20
Field Ambulance, which was permanently stationed as a
G.H.Q. unit in a chateau near Hesdin, had its accommodation
expanded in tents for the reception of 500 patients. With
this and the accommodation in No. 47 C.C.S., 1,000 wounded
could be accommodated at Hesdin. It was estimated that
No. 1 M.A.C. could make three return journeys between Hesdin
and Etaples in the twenty-four hours, the time taken between
Hesdin and Etaples being two hours. The journey from
Hesdin to Doullens took over one hour, and the convoy could
thus make at least two return journeys between Doullens and
Hesdin, or one return journey between Doullens and Etaples

THE SOMME BATTLES OF 1916 45

daily, should it be necessary to send it up to the casualty
clearing stations in the neighbourhood of Doullens. The
convoy could also make two return journeys between St. Pol,
Frevent and Etaples in the twenty-four hours. It was thus
estimated that No. 1 M.A.C. could clear approximately 1,000
wounded every twenty-four hours. But in the event of No. 1
M.A.C. being unable to meet the demand made upon it in
relieving congestion of casualty clearing stations in the Fourth
Army No. 26 M.A.C. at St. Omer was held in readiness to be
diverted to the battle area to assist No. 1 M.A.C, and an
improvised convoy was prepared at Abbeville for use in case
of need. Preparations were also made to relieve congestion
in casualty clearing stations of the armies, which were not
engaged in the battle of the Somme, by sending up convoys
from the base in the event of a large number of casualties
unexpectedly occurring.

It was fortunate that these arrangements for relieving
casualty clearing stations by evacuation by road, in anticipa-
tion of a possible breakdown in the arrangements for evacuation
by railway, had been made, as a breakdown actually occurred
during the first twenty-four hours of the battle.

The Assistant Director of Railway Transport was at Amiens,
and the D.M.S. of the Fourth Army was in direct communi-
cation with him with regard to the number of ambulance
trains or temporary ambulance trains which he required, and
the place to which they should be sent. The number garaged
in the army area before the battle commenced was only three,
and although others could have been brought up rapidly into
the area on the 1st July had sufficient notice been given, the
D.M.S. did not inform the A.D.R.T. until the afternoon of
the 1st July of the additional trains he required, so that the
full number of trains did not reach the army area until several
hours later.

Consequently, by the evening of the 1st July and during
the night of the 1st /2nd July the congestion in the casualty
clearing stations was acute, not only because of the failure of
a sufficient number of ambulance trains to come up into the
area, but also because the arrangements for clearing wounded
from the field ambulances to the casualty clearing stations
acted so well that the wounded came in much more rapidly
than was anticipated. Further, the favourable weather
conditions and, to a great extent, the increased capacity
of the narrow-gauge railway trains between Acheux

46 MEDICAL HISTORY OF THE WAR

and Gezaincourt,* added to the rapidity with which the
casualty clearing stations became filled during the first rush
of wounded. Unexpectedly large numbers of lightly wounded
came to Vecquemont, Heilly and Gezaincourt within a. very
short time of the first attack. Thus, during the first twenty-
four hours of the battle 863 officers and 22,826 other ranks
were admitted to field ambulances of the Fourth Army alone,
and of these, 797 officers and 13,603 other ranks had been
brought to the casualty clearing stations. In addition, there
were 304 wounded prisoners of war in the field ambulances,
of whom 16 had reached the casualty clearing stations, so
that, out of the total of 23,993 wounded who had been collected
to the field ambulances during the first twenty-four hours,
14,416 had been brought to the casualty clearing stations, a
number greatly in excess of the accommodation available in
the latter. Five ambulance trains were waiting to be loaded,
one each at Vecquemont, Puchevillers, and Gezaincourt, and
two at Heilly. They left during the day with 2,317 wounded,
so that on the night of the lst/2nd July the number in
the casualty clearing stations was 12,099, or some 2,500
in excess of the accommodation in them. It was then that
road and barge evacuation became imperative ; 2,222 were
cleared by road within the next twenty-four hours, and 120
by barges.

Fourteen ambulance trains and four temporary ambulance
trains were then brought up, and left the Fourth Army area
during the 2nd July, clearing a total of 11,299. The temporary
congestion was thus relieved, and at no subsequent period of
the operations did a similar occurrence take place, although
at one time the running of ambulance trains on the Amiens-
Albert line was interrupted by damage to the lines.

On the 2nd July, of the 14 ambulance trains, 4 ran to Vecque-
mont, 6 to Gezaincourt, 2 to Heilly, and 2 to Puchevillers.
In addition 2 temporary ambulance trains cleared from Heilly
and 2 from Vecquemont. Two barges cleared from Corbie,
and 2 from Amiens ; and, by road, No. 1 M.A.C. made one
journey from Beauval and Gezaincourt to Hesdin, and chara-
bancs and motor-bus convoys cleared from Corbie, Amiens and
Vecquemont to Abbeville, and from Gezaincourt to Frevent.

On the 3rd July, 17 ambulance trains and 6 temporary
ambulance trains cleared the casualty clearing stations,

* Instead of the 60 lying and 20 sitting cases for which they were originally
equipped, they carried 300 sitting cases and a few lying cases each ; and
four trains ran daily.

THE SOMME BATTLES OF 1916 47

3 ambulance trains and 1 temporary ambulance train from
Heilly, 5 ambulance trains and 1 temporary ambulance train
from Gezaincourt, 5 ambulance trains and 2 temporary ambu-
lance trains from Vecquemont, 3 ambulance trains and 2
temporary ambulance trains from Puchevillers, and 1 ambulance
train from Douilens. This was the day of maximum evacuation
from casualty clearing stations during the battle, and, in fact,
during the whole period of the war. The number evacuated
from the Fourth Army area by rail on this day was 13,556.
In addition 1,074 were also evacuated by road from Corbie,
Vecquemont, Puchevillers, Douilens and Beauval, and 300
by barges from Amiens, making a total of 14,930.

The following memorandum was issued by the D.G.M.S. on
the 10th July with a view to preventing any hitch in the
running of ambulance trains in preparing for future battles : —

" During the operations of last week the congestion that was felt in
casualty clearing stations on the evening of the 1st July and night of
lst/2nd July was due mainly to the unanticipated rapidity with which
wounded were collected from the field ambulances to the casualty clearing
stations and to the fact that the number of ambulance and temporary
ambulance trains required for clearing the latter did not reach the
Fourth Army area as early as they were expected.

" The favourable weather, and to a great extent the increased and
under-estimated capacity of the light railway trains from Acheux to
Gezaincourt, added to the rapidity with which casualty clearing stations
became filled during the first rush of wounded, while the non-arrival of
ambulance and other trains by the evening of 1st July was due to the
fact that the A.D.R.T. had not been informed until the afternoon of
1st July of the actual number of trains required, so that it was impossible
for the trains to reach the army area until several hours later.

" To avoid similar congestion of casualty clearing stations in the event
of operations of equal magnitude taking place, the D.M.S. will invariably
form an estimate of the number of ambulance trains and temporary
ambulance trains he is likely to require at a given time and place at least
twenty-four hours beforehand, and inform A.D.R.T. accordingly. This
estimate of the number of trains should be based on information received
from the General Staff and on experience of past operations. With
these as a guide there should be no great difficulty in calculating the
approximate number of lightly and severely wounded who are likely to
arrive at the different casualty clearing stations on any given day, and
of the number and class of ambulance trains required to meet the con-
gestion of wounded, which, with the present means of rapid collection
of wounded from field ambulances, invariably occurs in casualty clearing
stations on the evening and night following a big battle.

" Similarly the D.M.S. should inform the A.D.R.T. whenever he
anticipates that the rush of wounded and the numbers coming into
casualty clearing stations are diminishing and capable of being dealt
with by the normal running of ambulance trains, in order that the railway
authorities may be in a position to release the temporary ambulance
trains.

"It is essential that the temporary ambulance trains should not be
kept in commission longer than is necessary, and the D.M.S. should not
as a rule ask for them in order to meet a rush of wounded in connexion
with minor operations or operations in which the number of troops

48 MEDICAL HISTORY OF THE WAR

engaged is comparatively small. In such operations evacuation by the
ordinary ambulance trains, assisted by road evacuation, is generally
sufficient to meet requirements, and, in any case, Ds.M.S. should realize
the fact that temporary ambulance trains can always be formed and
brought up within twenty-four hours, notice being given by them to the
A.D.R.T. that they are required in a particular area."

On subsequent days during the whole period of the Battle
of the Somme the numbers requiring evacuation did not
approach these figures, and, as already stated, there was never
any difficulty in dealing with the situation.

The refusal to permit ambulance trains to run on the newly
constructed broad-gauge railway from Vecquemont to Contay
in the earlier phases of the battle was justified by the fact
that two of the ambulance trains sent up to Contay on this
line, after it was opened for ambulance trains, went off the
rails about one mile from Contay, when fully loaded, and it
was necessary afterwards to run on this line only the earlier
and lighter ambulance trains, which had been organized from
rolling stock in France in 1914.

The running of ambulance trains to the Reserve Army was
directed by the A.D.R.T. of the Third Army at Doullens, and
worked smoothly and efficiently.

Arrangements at the Base.

The accommodation in the hospitals on the L. of C. and in
convalescent and stationary hospitals in the front area was,
on the 1st July, approximately 61,000, including 1,300 for
Indians, and the number of beds vacant at the time in the base
hospitals was 30,602, including 428 for Indians, in convalescent
depots, 5,252, including 465 for Indians ; in stationary hospitals
in army areas, 383, making a total of 36,237, including 893
for Indians. Consequently, it became a matter of urgency
to clear a large number of wounded to the United Kingdom,
and in doing so a considerable number of slighter cases were
evacuated from France. As a result of this experience, the
convalescent depots in France were not only increased in number,
but were organized for as many as 5,000 convalescents at a
time, and a large convalescent depot to accommodate that
number was opened at Cayeux near the mouth of the Somme
on the 24th July.

The greatest number embarked on any one day during the
battle was 11,946, on the 6th July, a figure which also represents
the maximum number on any one day placed on board ships
during the war. On the three previous days in July the
numbers cleared from the base hospitals were 5,609, 8.350

THE SOMME BATTLES OF 1916 49

and 7,011. After that date evacuation overseas was carried
on at the rate of between 4,000 and 5,000 daily until the
9th July, and between 2,000 and 3,000 daily from then to the
15th July. The numbers evacuated from the Fourth Army
area alone during the Battle of the Somme are shown in
Appendix B, pp. 522-6.

The ambulance trains from the northern area of the battle
ran, as a rule, to Boulogne and Etaples, and from the southern
area to Rouen and Havre, Abbeville and Treport.

Arrangements for " Shell-shock " Casualties.

The question of the disposal of shell-shock cases arose during
the battles. All shell-shock cases were transferred to No. 3
Canadian Stationary Hospital at the Citadel, Doullens ; and
from the 12th November, onwards, the diagnosis of shell-
shock was not permitted to be made in any of the units further
forward ; cases of that nature were sent back under the
designation " not yet diagnosed." By the end of the year
arrangements had also been made for the reception and treat-
ment of these cases from the First and Second Armies at No. 4
Stationary Hospital, St. Omer ; from the Third Army area
at No. 6 Stationary Hospital at Frevent, and from the Fourth
Army at No. 21 C.C.S. at La Neuville, near Corbie. A specialist
in nervous disorders was appointed to each of the centres.
Consulting neurologists were also appointed, Lieut. -Colonel
Gordon Holmes for the Boulogne, Calais, Etaples bases, and the
Second and Third Armies ; and Lieut. -Colonel C. S. Myers
for the Abbeville, Treport, Dieppe, Rouen and Havre bases,
and for the Fourth and Fifth Armies.

Sickness during the Battles.

The health of the troops during the battles was good, but
a considerable number of cases of diarrhoea and dysentery
began to appear in August, and went on increasing during
September and October. The West India Regiment had
arrived from Egypt, and came into the Reserve Army area in
September with a considerable number of cases of dysentery
amongst the men. They appeared to have had an extensive
outbreak of diarrhoea on the voyage to France, but dysentery
had already appeared amongst the troops already there.

Owing to the constant movement of divisions from one area
to another the divisional sanitary sections were never able to

50 MEDICAL HISTORY OF THE WAR

maintain permanent sanitary arrangements in the area through
which they passed. Consequently, the D.D.G.M.S., after the
battle and in the absence of the D.G.M.S., brought the matter
to the notice of the A.G. and suggested that the divisional
sanitary sections should become extra-divisional troops and
allotted definite areas of work, thus causing their movements
with the divisions to cease. This method of enabling the
divisional sanitary sections to maintain a high standard of
sanitation in the billeting areas was carried out in the Fifth
Army area in December, but did not become a generally
authorized method of utilizing the divisional sanitary sections
until the following year owing to objections raised by the
Adjutant-General.*

Another innovation in the work of the divisions was the
establishment by a field ambulance of a scabies centre in
divisional and corps areas for the treatment of men suffering
from this complaint.

Casualties.

The medical services during the Battle of the Somme, con-
sisting as it did of a continuous succession of major and minor
operations alternatively during a period of five months, had a
strain thrown on them which was without parallel. Between
the 1st July and 30th November 1916, 316,073 wounded were
admitted to the field ambulances of the Fourth, Fifth (Reserve)
and Third Armies. In one month, July, the number in all
of the armies was 145,421, of whom 123,908 were wounded on
the Somme battlefields. In one period of twenty-four hours,
from 6 a.m. 1st July to 6 a.m. 2nd July, 26,675 wounded were
collected by the field ambulances. During July alone, 2,192
of the enemy wounded were also cared for by the British
medical services. The strain on individual casualty clearing
stations was probably even greater than that on the field
medical units. No. 29 CCS. at Gezaincourt received as many
as 5,346 in one day alone, during the twenty-four hours 6 a.m.
2nd July to 6 a.m. 3rd July, and 11,186 in the first three
twenty-four hour periods of the battle.

In addition to 289,363 evacuated by ambulance trains
between July and November 1916 from the Fourth, Fifth
and Third Armies, 8,739 were evacuated from the Fourth
Army by barges on the Somme, and 6,183 by road, of whom
4,198 were carried by motor ambulance convoy and 1,985

* See General History of the Medical Services, Vol. II, p. 62.

DAILY ADMISSIONS INTO FIELD AMBULANCES FOR WOUNDS . BATTLE OF THE SOMME, 1916.

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THE SOMME BATTLES OF 1916 51

by charabancs or buses. For evacuating these numbers
ambulance trains made, from the Fourth Army area alone, 491
journeys, temporary ambulance trains 31 journeys, barges
290 journeys, motor ambulance convoys 11 journeys, and
convoys of charabancs or buses 3 journeys.*

In addition to the wounded, provision had to be made for
the sick, of whom the average constantly in the care of the
medical units in the field armies numbered 13,766.

Casualties were also occurring in armies not actively engaged,
and the statistics for the whole year 1916 illustrate the extent
of the work thrown on the medical services in bringing wounded
and sick back from the army areas to the hospitals on the
lines of communication. The total number so carried by
permanent ambulance trains amounted to 713,957, and by
temporary ambulance trains 23,820, in 1,772 and 29 journeys
respectively. The numbers carried lying down were 306,690,
all by permanent ambulance trains, and the numbers carried
sitting up 431,087, of whom 23,820 were in temporary ambu-
lance trains. The average number carried on each journey
of a permanent ambulance train was 330, and of a temporary
ambulance train 821. The ambulance flotillas brought back
16,918 during the year, in 565 barge journeys, 7,916 were
evacuated by the flotillas Nos. 2 and 5 on the St. Omer-Aire-
La Bassee and Aire-Merville canal, and 9,002 by flotillas
Nos. 3 and 4 on the Somme Canal.

Yet, notwithstanding these colossal figures, the medical
services stood the strain with persistent cheerfulness and
undiminished vigour. This happy result * could only have
been achieved by careful preparation of the medical services
from the front line to the base, and by the loyal co-operation
of all those over whom the Director-General had administrative
control. The casualties amongst them were great, 52 officers
and 406 other ranks were killed, or died of wounds, during the
battles, and 188 officers and 2,107 other ranks were wounded ;
while 5 officers and 38 other ranks were reported missing.
The number of casualties in the R.A.M.C, Canadian, Australian,
New Zealand and South African Medical Corps, all of which
at one time, or another were engaged in the front area, is shown
in the following table.

* The medical services of the French Sixth Army, which fought on the
Somme on the right of the British Fourth Army, were reported to have
evacuated 105,672 wounded and 13,453 sick from their field medical units
during July to November. They employed six barges on the Somme Canal
and evacuated by them during July as many as 13,265 patients.

MEDICAL HISTORY OF THE WAR

Corps.

Killed.

Wounded.

Missing.

Officers.

O.R.

Officers.

O.R.

Officers.

O.R.

July.

R.A.M.C.
A.A.M.C.
N.Z.M.C.
C.A.M.C.
S.A.M.C.

129

58
2

744
39

Totals

134

818

August.
R.A.M.C.
A.A.M.C.
N.Z.M.C.
C.A.M.C.
S.A.M.C.

7
1

46
10

183
43

—

4
2

Totals

226

—

September.
R.A.M.C.
A.A.M.C.
N.Z.M.C.
C.A.M.C.
S.A.M.C.

1
1

102

488

100

4
15

Totals

139

674

October.
R.A.M.C.
A.A.M.C.
N.Z.M.C.
C.A.M.C.
S.A.M.C.

32
6

20
7

164
38

Totals

202

—

November.
R.A.M.C.
A.A.M.C.
N.Z.M.C.
C.A.M.C.
S.A.M.C.

31
6

143
33

—

Totals

187

—

Grand Totals . .

406

188

2,107

THE SOMME BATTLES OF 1916

For all armies the casualties amongst medical officers between
the 25th June 1916 and the 14th November 1916 were con-
siderably greater, as shown in the following table : —

Killed or
Died of
Wounds.

Wounded.

Missing.

Totals.

Field Ambulance M.Os. . .
Infantry Battalion M.Os.
Artillery M.Os.
Administrative Staff
Casualty Clearing Station M.Os.
Sanitary Officers

149

85
196

27
3
6
2

Totals

241

319

CHAPTER III.

THE ADVANCE TO THE HINDENBURG LINE IN 1917.

THE winter of 1916-17, following the battles of the Somme
and Ancre, was one of great severity, with continuous
frost and much snow. When the thaw came many of the
roads were badly damaged, and this interfered considerably
with the smooth running of motor ambulance transport, es-
pecially along collateral routes of evacuation. Repairs were,
however, actively undertaken, and by the time the spring
offensive of 1917 commenced roads were in fair condition along
the main lines of evacuation, although the collateral routes
were still in a very bad state.

The British line had been extended south of the Somme
during February as far as the Amiens-Roye road to a point
about four miles north-west of Roye ; the whole British front
was then 110 miles in length, occupied by the Fourth Army
on the right from the Roye road to opposite Le Transloy,
by the Fifth Army to opposite Serre, by the Third Army to
Arras, by the First Army to Armentieres, and by the Second
Army on the extreme left to Ypres. At that time preparations
were being made for a general offensive with a view to cutting
off the enemy salient between Arras and Le Transloy ; but,
before the winter had set in and during January, February
and March 1917, the Fifth Army continued its pressure in the
Ancre region and advanced its line to Grandcourt, Miraumont,
Serre, Gommecourt and Irles, so that the salient in this area
had been reduced to a continuous front facing Bapaume.
The enemy then withdrew to his new defensive system, the
Hindenburg line, which ran roughly from Tilloy-les-Mafflaines,
immediately south-east of Arras, through Neuville Vitasse,
Bullecourt, Quean t and Havrincourt to St. Quentin. His
retreat was closely followed up by Fourth and Fifth Army
troops and the right sector of the Third Army from the 17th
March onwards, so that by the beginning of April these armies
were established on a line facing the enemy's defences from
Arras in the north to St. Quentin in the south. Both during
and after the battles, which commenced on the 9th April
on the Arras and Vimy Ridge front, continuous pressure was
maintained against this line, occasionally with fiercely fought

ADVANCE TO HINDENBURG LINE IN 1917 55

local attacks, especially at Bullecourt, until the more extensive
operations of the summer and autumn of 1917 led to a complete
readjustment of the British front and a rearrangement of the
army areas.

Medical Preparations for the Advance.

The medical arrangements for the advance to the Hindenburg
line and for the subsequent battles of Arras and Vimy Ridge were
made by the Ds.M.S. of the armies engaged, and the D.G.M.S.
at G.H.Q. was scarcely called upon to make any special pre-
parations for them beyond co-ordinating the work and building
up a strategical situation adapted for the proposed spring
offensive. The chief anxiety felt by the D.G.M.S. was with
regard to the number of hospital beds vacant on the lines of
communication.

On his behalf the D. D.G.M.S. held a conference at Hesdin
of Ds.M.S. of Armies and of the L. of C. on the 2nd April, when
the general strategical position of the medical services with
regard to the coming offensive, and the policy which it was
desirable that the Ds.M.S. should follow, were explained.
Broadly, the policy was for the Second and Fourth Armies,
which would not be actively engaged, either to retain as many
of their sick and wounded as possible in the army area, in order
to avoid the necessity of sending ambulance trains to them
until the pressure had decreased, or to relieve congestion in
their units by road evacuation to hospitals in St. Omer and
Abbeville. The Fifth and Second Armies were also to be
prepared, if necessary, to receive wounded by lateral routes
of evacuation from the Third Army and the First Army
respectively. The Directorate of Transportation had arranged
to repair certain roads for these lateral means of evacuation.

Anxiety regarding Hospital Accommodation. — During the five
months of the Somme battles the number of sick and wounded
that were evacuated from France averaged over 70,000 monthly,
but after that period there was a tendency to retain sick and
wounded in France instead of evacuating them to England.
Thus, during December 1916 and January and February 1917
the numbers sent out of France were less than 40,000 in each
of these months. Consequently the number of permanently
equipped beds which remained vacant gradually became less
and less until, on the eve of the offensive against the Arras-
Le Transloy salient, with an anticipated casualty list of some
30,000 during the first twenty-four hours, the number of these
vacant beds in hospitals on the L. of C. was little more than

10134 F

56 MEDICAL HISTORY OF THE WAR

7,000 on the 22nd February 1917, with about the same number
in convalescent depots, and some 2,000 in stationary hospitals
in army areas. The situation was so critical that the D.D.G.M.S.
was sent to the War Office, where he had a conference on the
subject with the A.G., the D.G.A.M.S., and others on the
24th February. Two alternatives were then suggested, one
was to increase the evacuation from France to 4,000 daily for
a week or ten days in order to have a margin of 30,000 to
40,000 vacant beds, or to add 20,000 beds to the hospital
accommodation in France by expansion and mobilize more
general and stationary hospitals. For this purpose it was
suggested that five general and nine stationary hospitals
should be sent to France. Ordnance equipment for this
expansion of beds was available, but the chief difficulty was
lack of medical personnel. The D.G.M.S. in France was
prepared, however, to accept for general and other hospitals a
reduced establishment of one medical officer for every 100 beds.
But the only immediate measure possible for relieving the
congestion of the base hospitals in France was increased
evacuation to England, and the A.G. agreed to the numbers
evacuated daily being doubled until a sufficient number of
vacant beds was obtained. This was carried out immediately
after the D.D.G.'s visit, and the vacant beds gradually increased
until, on the 13th March, the number exceeded 30,000, and
remained above that figure until the beginning of April, when
the vacant beds were again rapidly filled by the unloading of
sick who had been retained in army areas in anticipation of
the approaching battles.

Reconnaissance for New Hospital Centres. — In order to avoid
similar conditions in future, the A.G. at the War Office asked
that a reconnaissance should be made of the areas south of
the Seine with a view to the selection of additional sites for
hospital centres and convalescent depots. Sites in Brittany
had been suggested, but hospital centres far from the front
line had many disadvantages, and, although reconnaissances
were made in the vicinity of Brest, Cherbourg and elsewhere,
the proposal to send the sick and wounded to Brittany was
abandoned. Subsequently a site near Deauville-Trouville was
selected. It was not ready, however, to receive convalescents
or others until the following August. The proposal to send
over five general and nine stationary hospitals resolved itself
into seven new general hospitals of 1,040 beds each being
organized from existing Territorial Force general hospitals.
They arrived in France in April 1917.

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ADVANCE TO HINDENBURG LINE IN 1917 57

Estimate of Ambulance Train Requirements. — The number of
ambulance trains which were likely to be required for the
offensive had been considered by the D.D.G.M.S. in consulta-
tion with the Directorate of Transportation. At the beginning
of 1917 the following daily journeys of permanent ambulance
trains were estimated as likely to be necessary in preparing
for the offensive : —

First 24 hours

18 ambulance

trains for 8,000

Second ,,

i > > >

Third

Fourth

> > > >

Fifth

5,000.

Sixth

4,000.

Seventh

3,000.

These were calculated on the assumption that during the
first three periods of twenty-four hours between 40 and 50
per cent, of the wounded could be dealt with by temporary
ambulance trains supplemented by road evacuation to the
base, or by road evacuation to casualty clearing stations of
armies not actively engaged. But after the first three days
it was calculated that the wounded left in the casualty clearing
stations would be of a more severe type, and that, therefore,
a larger proportion would require evacuation by permanent
ambulance trains than by temporary trains. The number of
temporary ambulance trains, therefore, required during the
first three periods of twenty-four hours was estimated at
nine daily, for the fourth period four, and for the fifth and
sixth periods one each.

The requirements as estimated by the D.D.G.M.S. were,
consequently, for 54 journeys by permanent ambulance trains
and 27 journeys by temporary ambulance trains during the
first three days for the purpose of evacuating 48,924 wounded.
This was the estimate of probable requirements before the
Germans had withdrawn from the Arras-Le Transloy salient,
and was therefore considerably in excess of what was eventually
necessary. It was, however, believed at the time that the
casualties requiring evacuation from casualty clearing stations
would be considerably greater than during the earlier days of
the Somme battle, during the first three days of which 35,814
were evacuated from the Third and Fourth Armies.

Arrangements for Lightly Wounded and Sick. — Some anxiety
was felt with regard to the running of the ambulance trains.
The main line railway ran south from Lapugnoy to St. Pol,
Frevent, Doullens and Gezaincourt to Abbeville, and was
joined by branch railway lines running from casualty clearing

(10134) F*

58 MEDICAL HISTORY OF THE WAR

station centres at Warlincourt, Agnez les Duisans, Aubigny,
Bruay, Barlin, Coupigny, Bethune, and Noeux-les-Mines. In
consequence of the military necessity of restricting the number
of ambulance trains running on the branch lines to these
casualty clearing station centres, it was essential that as many
as possible of the sick and wounded should be brought by road
to medical units on the main line. The medical units at St.
Pol, Frevent, Doullens and Gezaincourt were consequently
kept chiefly for the sick and wounded who could be transferred
to them in lorries or buses. No. 29 CCS. at Gezaincourt
was in the Fifth Army area, and although before the battles
the D.M.S. of the Fifth Army wanted to close Gezaincourt

Regimental aid post in Hindenburg Trench.

and Varennes and transfer the casualty clearing stations
there to a more forward area, the policy of G.H.O. made it
necessary to retain them, in case they might be required for
the reception of sick and wounded brought to the main line of
railway at Gezaincourt or from the Third Army by the lateral
routes leading to Varennes and thence to Gezaincourt.

The Medical Services during the Advance.

During the advance to the Hindenburg line the work of the
medical services presented few features that were new. Unlike
the only previous operations with which they were comparable,
namely ; the advance to the Aisne in September 1914, the
arrangements for the collection and evacuation of casualties
followed a methodical and organized system, under army,

ADVANCE TO HINDENBURG LINE IN 1917 59

corps and divisional administrative medical control. Regi-
mental aid posts, advanced and main dressing stations, and
walking wounded collecting posts were established in echelons
conforming with each forward movement. The work of the
bearer divisions, however, was much hampered during these
operations by the condition of the ground and roads over
which the advance had been made. The roads were broken
by shell-holes and mines, and the ground off the roads was deep
in mud. The bearers worked from the regimental aid posts
over this broken country by a system of relay posts.

The Ilnd Corps 'Medical Services. — The advance on both
flanks of the Ancre Valley was made by divisions of the Ilnd
Corps, and south of the Albert-Bapaume road by divisions of
the 1st Anzac Corps. The Ilnd Corps divisions were the 2nd
on the right, the 18th in the centre, and the 63rd (R.N.) on
the left. The work of the front line medical services and
the physical conditions with which they had to contend
during the advance are well described in the following account
by the A.D.M.S. of the 18th Division (Colonel J. Poe) and
by the accompanying map.

" On 1st January 1917 the 18th Division were in rest with the Ilnd
Corps near Abbeville.

On 11th January they marched forward, and on the 16th took over
from the 61st Division the portion of the line south of the Ancre that
they had previously held in December.

The division was warned that the Ilnd Corps (63rd, 18th and 2nd
Divisions) were to attack in about a month's time.

The 63rd Division were astride the River Ancre, the 18th Division held
the line from about 700 yards south of Grandcourt to some 1,000 yards
south of Petit Miraumont, and the 2nd Division were to the east of the
latter point.

The chief problem of all services was the extraordinary difficulty of
transport.

East of the Ancre there were four possible lines of evacuation : —

1. The river road, Hamel-St. Pierre Divion.

2. Nab Valley road, running from Aveluy to near Moquet Farm.

3. Centre road running to Aveluy-Ovillers — R.33.d. Central.

4. The Albert-Bapaume road.

There was also a cross-road connecting Nab Valley road with Pozieres,
but in bad weather this was impassable for wheeled traffic at the head of
Nab Valley, and was very bad but just passable near Pozieres Cemetery.

The other roads were all in a very bad condition, but were passable for
motor ambulances.

All the country in front of the line held on 1st July 1916 was impassable
even for pack animals except on made roads, and the only way of con-
veying wounded north-east of the line St. Pierre Divion-Pozieres was
either by stretchers along duckboards, or by a single line of light railway
track, along which trucks were pushed by hand.

The accommodation east of the Ancre consisted of an advanced dressing
station at Aveluy Post, and, east of that, of two or three German dugouts.

The Ilnd Corps selected Aveluy Post as their main dressing station.

60 MEDICAL HISTORY OF THE WAR

The 18th Division chose the Quarry crossing north-west of Pozieres as
the site for their advanced dressing station.

About 18th January, five weeks of hard frost commenced, and the
whole of the wet mud froze to the hardness of a metalled road ; this made
transport much easier, but made it excessively difficult to do any digging,
and excavations for dugouts could only be made with the assistance of
explosives.

The following accommodation was made : —

At the advanced dressing station, Quarry Crossing — four elephant

hutches.
Rifle Dump between Pozieres and Courcelette — two elephant

hutches.
Hessian Trench, near tramhead, Valley of Death — one tunnelled

dugout (bearer relay post).
Regina Trench, slightly north of Hessian Trench — one tunnelled
dugout.
The site for the advanced dressing station was chosen because it was
the point at which the tramway cut the furthest forward road. The
site was shelled occasionally, and therefore dugouts were necessary.
These were made with steel shelters (elephant hutches). Other similar
shelters were installed in a small depression at the Rifle Dump.

In front of this the whole country was in full view of the enemy and
only tunnelled dugouts were safe. It was, however, very difficult to
treat stretcher cases in tunnelled dugouts, and, moreover, the surrounding
sea of mud made any surgical treatment especially difficult.

The system adopted was to obtain tunnelled dugouts as shelter for
bearers and instruct all ranks that the all-important point was to get
all wounded back as rapidly as possible, the first place where full dressings
could be done being at the advanced dressing station at Quarry Crossing.
The evacuation of wounded was entirely dependent upon the tramline,
which the R.A.M.C. assisted to build ; this ran from Aveluy Post through
Ovillers, Quarry Crossing, Rifle Dump to tramhead at Hessian Trench.

On 3rd February the 63rd Division advanced north of the Ancre and
the enemy evacuated Grandcourt on 6th February.

On 7th February the 18th Division took Folly Trench, east of Grand-
court, with light casualties.

On 9th February the 18th Division took over the line up to the south
bank of the Ancre.

On 15th February the thaw commenced and the whole country-side
turned into a sea of mud ; motor ambulances could still proceed along the
metalled roads shown in the map, but these became very difficult. The
important lateral communication Thiepval-Pozieres road became
impassable for wheeled traffic near Moquet Farm and almost impassable
for motor ambulances at Pozieres. The Ovillers road remained passable,
but only east-bound traffic was allowed along it ; the advanced dressing
station was therefore in great danger of being cut off from all connexion
with the rest of the world.

On 17th February the 18th Division took Boom Ravine; about 500
walking wounded and 180 stretcher cases were evacuated between
8 a.m. and 8 p.m. The stretcher cases were carried to tramhead at
Hessian Trench, a distance of 2,400 yards ; they were then pushed along
the tramline for 2,300 yards to the advanced dressing station. Thence
a number were conveyed by petrol trains direct to Aveluy Post ; others
were carried 600 yards down the road to the head of Nab road and
thence cleared by motor ambulances.

The regimental medical officers had aid posts in Boom Ravine, and the
bearer officers did dressings in a German gun-pit a little to the south-east.
Four relays of bearers were required to carry from Boom Ravine to the
tramhead north of Rifle Dump. This carry was uphill all the way,
over ground completely destroved by shell-fire and knee deep in mud,

ADVANCE TO HINDENBURG LINE IN 1917 61

and the whole course was shelled heavily all day. It was the heaviest
work our bearers ever had to perform. ; all the bearers of the three field
ambulances were employed. All the wounded were cleared by 6 p.m.

After this attack there was a lull for eight days, during which time
efforts were made to repair the damage done by the thaw to the roads
and tramlines.

On 25th February it was reported that the enemy had evacuated
Miraumont, and on the 26th the 18th Division had occupied Miraumont
and Pys and were holding the line in front of Irles.

Evacuation of wounded now became very difficult, as there was no
road east of the line St. Pierre Divion-Pozieres passable for wheeled
traffic except the Albert-Bapaume road, which lay too far south to be
of any use.

The following line of evacuation was formed : —

Regimental aid post and advanced bearer relay at Red Cross Gulley,

2,000 yards from front line.
2nd bearer relay south-east of Petit Miraumont.
3rd relay at head of Boom Ravine.
4th relay at Oxford Circus.
5th relay at Valley of Death.
6th relay at Tramhead.
7th relay at Rifle Dump.

8th relay at Quarry Crossing advanced dressing station.
This line involved a stretcher carry of 5,000 yards, followed by a tram
journey of 2,400 yards.

The tramline could only be worked by pushing by hand. It effected
a great saving of personnel, as four men could push four patients, never-
theless the work involved was as hard as carrying a stretcher.

As the advanced dressing station at Quarry Crossing was now safe
from shell-fire, the accommodation there was increased by levelling the
ground and erecting tents, sufficient to form a divisional main dressing
station, but, unfortunately, the roads leading to it went steadily from
bad to worse.

During the first week in March great efforts were made by the division
to push the tramway forward and repair the river road through Grand-
court.

On the 10th March the division took Irles, and on 13th March the
enemy retired to Achiet le Grand.

The roads through Miraumont and Irles were found to be practicable
for wheeled stretchers, and cases were taken to Miraumont by wheeled
stretchers and thence carried by hand to the new tramhead south of
Petit Miraumont, and thence pushed by hand 5,500 yards to Quarry
Crossing. Fortunately the casualties were very light.

On the 17th March the enemy evacuated the Achiet le Grand* line
and retired to Croisilles.

On the 18th the division occupied St. Leger. An advanced dressing
station was formed at Bihucourt in a factory the enemy had not destroyed.
Empty horse ambulances were got forward through Grandcourt and
Miraumont and worked between St. Leger and Bihucourt ; another relay
of horse ambulances worked from Bihucourt to Miraumont, thence cases
were evacuated along the tramlines as the Grandcourt road was too bad
to send loaded horse ambulances along.

On the 19th one Ford car was got forward through Bapaume to
Bihucourt and worked between St. Leger and Bihucourt.

The work of evacuation was assisted by the light horse ambulances
of a cavalry division which came forward with the 18th Division.
The line of evacuation was therefore as follows : —

St. Leger — Bihucourt — Petit Miraumont : 13 miles by horse

ambulances.
Petit Miraumont — main dressing station at Quarry Crossing :
three and a quarter miles by push tramline.

MEDICAL HISTORY OF THE WAR

On the 20th the 18th Division attacked Croisilles, and had 50 casualties.
On the night of the 20th the 18th Division were withdrawn to rest.

The history of the medical arrangements of the 18th Division during
these three months is simply the story of a struggle against difficulties
of transport. Evacuation of wounded would have been impossible
without the use of tramways, unfortunately the petrol tractors were
only of a limited use, as the forward lines had to be laid so hurriedly as
to be unfit to carry the tractors.

714E Advance to the Hindenburg Line.

TT Corps Front.

MOTOJZ. AMBS.

The line Aveluy Post-Quarry Crossing was used on 17th February
with great success, but the same day its use was forbidden for wounded
by the Ilnd Corps on the ground that this use delayed the bringing up
of ammunition.

The evacuation of wounded was very seriously handicapped throughout
the period under consideration by the appalling state of the few existing
roads behind our lines, the roads between the River Ancre and the
Thiepval-Pozieres line often became impassable in places even for
horse ambulances, and west of the River Ancre, between Aveluy and the
casualty clearing stations at Varennes or Contay, the roads were also

ADVANCE TO HINDENBURG LINE IN 1917 63

in a very bad condition, and the journey of ten to twelve miles back
to the casualty clearing stations was very bad for the seriously wounded.
This journey was greatly shortened when casualty clearing stations at
Edgehill came into the Fifth Army area about the 10th February.

During the advance from Miraumont-St. Leger the value of horse
ambulances was brought out in a most striking manner. Without them
it would have been impossible to have evacuated the wounded from
St. Leger."

The Medical Services of the 1st Anzac Corps. — In the advance
to Bapaume between the 14th March and 5th April the medical
services of the 1st Anzac Corps were chiefly involved. The
tramline ran to the advanced dressing stations at Le Sars,
on the Albert-Bapaume road, and at Factory Corner between
it and Guedecourt over an area pitted with shell-holes, and the
work of carrying the casualties back to them was similar to
that described above. The Factory Corner line was extended
on the 18th March to Warlincourt, and casualties could then
be brought back by it to the main dressing station at Bazentin-
le-Petit. The petrol tractor trains were a great help, as
casualties could be brought to the dressing station in half an
hour instead of three and a quarter hours, which would have
been the time required had the whole carrying to be done
by hand.

Motor ambulance convoys were able, as a rule, to come up
to the main dressing station positions, but the journey back
to the casualty clearing stations was considerably longer than
during the Somme operations. The chief difficulty was the
broken state of the roads after the thaw.

The Casualty Clearing Stations. — The casualty clearing
stations remained grouped in the positions to which they had
been moved in the later phases of the Somme battles, while
the main dressing stations advanced. Consequently when the
advance to the Hindenburg line had been made, the chief work
of the medical services in the armies concerned consisted in
selecting new sites for groups of casualty clearing stations in
more advanced positions in the area taken from the enemy,
and establishing them there.

The Fourth Army, which had taken over the area north and
south of the Somme from the French, took over the huts
of several excellently organized French field ambulances and
clearing hospitals, notably near Bray, Gailly and Cayeux,
and also brought casualty clearing stations forward to Peronne-
la-Chapelette, Nesle, Tincourt and Ytres, closing its former
casualty clearing station centres at Allonville, Corbie, Heilly
and Grovetown. Edgehill, its remaining centre, had come

64 MEDICAL HISTORY OF THE WAR

into the Fifth Army area in February on the Fourth Army
extending its front south of the Somme. Tincourt and Ytres
then became the chief casualty clearing station centres of the
Fourth Army, the former being close to the main Peronne-
Gambrai railway line and the latter near a new broad-gauge
railway. Ambulance train sidings were constructed at each
of these centres. Two casualty clearing stations (Nos. 48 and
21) were established at Ytres, and four (Nos. 39, 36, 5 and 13)
at Tincourt, No. 39 and No. 13 having been transferred from
Gailly and replaced there by a stationary hospital (No. 41)
from the lines of communication.

The new sites for groups of casualty clearing stations in
the Fifth Army area were at Achiet-le-Grand and Grevillers.
The sites at Puchevillers and Contay were then given up, as
also Recmenil Farm and Gezaincourt, but the last of these
sites, with No. 29 G.C.S., was retained, as already noted, by
instructions from G.H.Q., until May, when the Arras battles
were coming to an end. Two casualty clearing stations were
established at Achiet-le-Grand, near the main line of railway
from Albert to Arras, and three at Grevillers, in open fields
on either side of a new broad-gauge railway. The group of
casualty clearing stations at Varennes was retained, but with
two in place of three, and a single casualty clearing station was
kept at Edgehill. Single units were also placed at Aveluy
and Colincamps.

The medical services of the Fourth and Fifth Armies
during the ensuing battles of Arras were thus chiefly engaged
in establishing these new posts and organizing advanced
and main dressing stations, divisional and corps rest stations,
and special centres for the treatment of scabies, nervous
disorders, and dentistry in their new areas. The special
preparations for the battles of Arras and Vimy Ridge were
confined to the Third and First Armies.

CHAPTER IV.

THE BATTLE OF ARRAS, 1917.

AS mentioned in the previous chapter the Third Army had
been making preparations for an offensive directed south-
wards against the right flank of the enemy's salient between
Arras and Le Transloy, but, on the Germans withdrawing to
the Hindenburg line, these were converted into preparations for
a combined offensive of the Third and First Armies against
the positions between Arras and Lens. For these operations
the Third Army had taken over from the First Army the
XVIIth Corps, which was occupying the sector between Arras
and the Vimy Ridge, and with it, in January, also the casualty
clearing stations (No. 30 and No. 42) in Aubigny. The Vllth
Corps was in the sector south of Arras, and the Vlth Corps in
the Arras sector ; with the XVIIIth and XlXth Corps in back
areas for divisions in reserve or brought back for rest.

The 1st, 2nd and 3rd Cavalry Divisions of the Cavalry Corps,
with the headquarters of the corps, also moved into the Third
Army area behind Arras, ready to exploit any successes of the
divisions attacking the German line ; the 2nd Cavalry Division
behind the Vllth Corps, the 3rd Cavalry Division behind the
Vlth Corps, and the 1st Cavalry Division behind the XVIIth
Corps.

Medical Preparations for the\Battle.

The Casualty Clearing Stations. — The D.M.S. of the Third
Army (Surg.-General J. M. Irwin) had three main groups of
casualty clearing stations, three at Warlincourt Halte (Nos. 20,
43 and 32) in the Vllth Corps area, three at Agnez-les-Duisans
(Nos. 19, 41 and 8) in the Vlth Corps area, and four at Aubigny
in the XVIIth Corps area, No. 1 Canadian from the Second
Army and No. 24 from Egypt having been added in March to
the two already there.

The Warlincourt Halte group was seventeen or eighteen miles
distant from the front line of the Vllth Corps, and sites in a
more forward position were considered, but until the enemy
withdrew to the Hindenburg line sites further forward in this
corps area were too dangerous, owing to their being exposed to
hostile fire from the salient south of the Arras-Doullens road ;
while after the Hindenburg line had been reached it was too
late to organize for the Arras battle a new group of casualty

10134 G

66 MEDICAL HISTORY OF THE WAR

clearing stations in a more forward position. Casualty clearing
stations consequently remained at Warlincourt Halte until
after the battle, but an advanced operating centre for abdominal
wounds and for urgent operations was opened at a main
dressing station at Ficheux during April, some 11,000 yards
behind the front line.

After the fighting in the Arras area had died down and the
new line held by the British was advanced to between five and
six miles east of Arras, the casualty clearing stations at Warlin-
court were moved forward to the neighbourhood of Boisleux-
au-Mont, between the Arras-Boiry Ste. Ric trade road and
the railway line.

A broad-gauge railway was under construction from Warlin-
court Halte to join the Arras-St. Pol line near Duisans by way
of Wanquetin ; and Wanquetin was originally regarded as a
suitable advanced site for the group of casualty clearing stations
in the Vlth Corps area ; No. 41 CCS. had been moved to it
from Doullens at the end of 1916 before the railway had been
completed. For military reasons, however, the site had to be
abandoned as a casualty clearing station centre towards the
end of February. A new site had been selected near the same
railway line at Agnez-les-Duisans, where a group of three
casualty clearing stations (No. 19 from Doullens, No. 41 from
Wanquetin, and No. 8 from Bailleul in the Second Army area)
was established by the beginning of March. An ambulance
train siding was constructed to it from the new line of railway.
The site was just south of the Arras-St. Pol road and not more
than 11,000 yards from the Vlth Corps front line. It was
consequently within the danger zone of hostile artillery, and in
fact enemy shells passed over it to the fields beyond, as well as
doing damage in the village of Duisans, to the east of the site.
The casualty clearing stations, however, remained untouched,
and owing to their convenient proximity to Arras were not
abandoned. They were allotted for the reception of wounded
from the Vlth Corps and for wounded in need of urgent
operation from medical units of the XVI I th Corps.

The group at Aubigny was allotted for the reception of
XVIIth Corps wounded. The two origpijally there were close
to the railway station on the south of the line, one of them on
the site and in the huts of a French clearing hospital ; but No. 1
Canadian and No. 24 Casualty Clearing Stations were opened
under canvas in fields, with a bad approach road, on the north
of the line. These latter were allotted subsequently for the
reception of wounded from the First Army, but they remained

MEDICAL SITUATION OF THE
BATTLES OF ARRAS & VIMY RIDGE
APRIL 1917 .

Casualty Cleaning Station

1218. 2*34° 506C l4'.lS00-8'23

MalbyASonsLith.

THE BATTLE OF ARRAS, 1917 67

for purposes of evacuation under the administrative control of
the D.M.S, of the Third Army.

In addition to these groups for the three corps in the line,
there was one casualty clearing station, No. 37, at Avesnes-le-
Comte, another at Doullens, No. 62, and a third, No. 63, which
had recently arrived from England, at Boubers-sur-Canche, in
factory buildings on the Canche river, some three miles west
of Frevent. These were used for the reception of sick from
divisions in the line and back areas, and for slighter cases of
wounds. There were also two stationary hospitals, No. 12 at
St. Pol, and No. 6 at Frevent, to which wounded able to sit up
were to be taken by road or by the narrow-gauge railway which
ran from Warlus, through Avesnes-le-Comte, to Frevent.

On the 5th April each of the casualty clearing stations in the
Warlincourt, Agnez-les-Duisans and Aubigny groups were
reinforced by surgical teams, six teams being sent from casualty
clearing stations in the Fifth Army, and four from the casualty
clearing stations in the Second Army by order of the D.G.M.S.
In addition the D.M.S.,L. ofC, was ordered on the 5th April to
send a medical officer to each of these casualty clearing stations
from base hospitals, and on the 12th April ten more medical
officers were ordered to the Third Army casualty clearing
stations from the Second Army. Fourteen nursing sisters, in
addition to those who came with the surgical teams, were sent
to the Third Army by the Matron-in-Chief , and ten more were
subsequently sent to Aubigny on the 11th April. The hospitals
at the base, however, were not called upon to supply surgical
teams ; but forty emergency stretcher bearers were sent for
duty at the casualty clearing stations from the L. of C. before
the battle and further reinforcements during the battle.

When the advanced operating centre was opened in the
Vllth Corps area surgical teams and nursing sisters were sent to
it ; and also to an advanced operating centre which was opened
on the 17th April in the Hopital St. Jean in Arras by a field
ambulance of one of the Vlth Corps divisions.

In addition to these reinforcements from outside the Third
Army, the D.M.S. of the army issued instructions for corps to
send to each of the casualty clearing stations allotted for the
reception of their wounded 3 officers, 3 N.C.Os. and 24 other
ranks, or practically a tent sub-division, from field ambulances
of their divisions. A number of men was also attached to the
casualty clearing stations for temporary duty from labour and
other units.

The casualty clearing stations of the Third Army receiving

68 MEDICAL HISTORY OF THE WAR

■

the wounded from the battle front had thus from twelve to
fourteen medical officers each in addition to dental surgeons
and chaplains who assisted in the work, and a considerable
reinforcement of nursing sisters, R.A.M.C. orderlies, stretcher
bearers, and men of categories unfit for the fighting line.

The Motor Ambulance Convoys. — The motor ambulance
convoys in the Third Army area were No. 3 at Gouy-en-Artois,
No. 15 at Louez, north of the Arras-St. Pol road, about three
miles from Arras, No. 24 at Aubigny and No. 16 at Frevent.
The first three of these were placed at the disposal of the
D.Ds.M.S. of the Vllth, Vlth, and XVIIth Corps respectively,
and No. 16 was retained under the direct control of the D.M.S.
An additional convoy, No. 31, from the Fifth Army was temp-
orarily attached by orders of the D.G.M.S. It was placed by the
D.M.S. of the Third Army at the disposal of the D.D.M.S.,
Vllth Corps, owing to the length of the journey to the casualty
clearing stations allotted for his wounded.

The convoys were supplemented by 45 charabancs or motor
buses, 10 of which were given to the Vllth and Vlth Corps and
20 to the XVIIth Corps, the remainder being kept under the
direct control of the D.M.S. They were employed for the
transport of sitting cases to Douliens, Frevent and St. Pol ;
and were still further supplemented by as many lorries as could
be made temporarily available from army or corps resources
and casualty clearing stations, in order to carry out the general
policy of bringing as many of the sitting-up cases to the units
on the main line of railway running through Douliens, Frevent
and St. Pol, where they could be loaded into temporary ambul-
ance trains and thus leave the lines leading to the casualty
clearing station groups free for the permanent ambulance trains.

Evacuation from Oasualty\Clearing Stations.
The Third Army directorate of railway transport had garaged
eight ambulance trains and three temporary ambulance trains
in or near the casualty clearing stations before the attack was
launched. During the first twenty-four hours of the battle,
from 9 a.m. on the 9th April to 9 a.m. on the 10th April, all
these ambulance trains and one of the temporary ambulance
trains were available and took back wounded from the Third
Army area. A maximum of journeys was reached during the
next forty-eight hours, when twenty ambulance and five tem-
porary ambulance train journeys were made during that time.
The general arrangements for the running of the trains proved
remarkably efficient, and there was never at any time delay or

THE BATTLE OF ARRAS, 1917 69

difficulty in keeping the casualty clearing stations free from
congestion. Altogether during the period of active hostilities
in April the ambulance trains made 129 journeys and temporary
ambulance trains fifteen to the area of the Third Army. The
only mishap that occurred was on the 11th April, when an
ambulance train from Warlincourt Halte came into collision
with another train, but was able to continue the journey,
although the line was blocked for several hours.

Medical and Surgical Supplies.

Advanced depots of medical stores were placed at Savy, near
Aubigny, Frevent, and Doullens ; and there was no lack of
medical and surgical equipment or appliances.

Ample reserves of stretchers and blankets were also provided,
and their distribution followed the method generally employed
in previous battles ; 2,000 stretchers were issued by the D.M.S.
of the Army as a reserve to each corps D. D.M.S. and 500 to
each casualty clearing station. These arrangements were built
up in association with more detailed preparations of the
D.Ds.M.S. of each of the corps and the A.Ds.M.S. of divisions.

The Casualties.

The total casualties received into the Third Army medical
units during April were 2,002 officers and 43,476 other ranks,
of whom 135 officers and 3,722 other ranks were from other than
Third Army formations. As in practically all the battles of the
Western front, the maximum number of wounded was during
the first twenty-four hours, when 445 British and 6 German
officers, and 9,719 British and 1,350 German other ranks were
admitted. The casualties amongst the personnel of the
medical services were severe. Six officers and 57 other ranks
were killed and eighteen officers and 278 other ranks wounded.

The Meiical Services of the Vllth Corps.

The Vllth Corps was composed of the 21st, 30th, 56th
and 14th Divisions, and held a line from Croisilles to the
southern outskirts of Arras. A corps main dressing station was
established at Gouy-en-Artois in twenty-seven Nissen huts ;
and a walking wounded collecting station at Agny for the three
divisions on the left and in the centre, and at Boiry for the 21st
Division on the right of the attack. Each division opened an
advanced dressing station, the 21st at Boiry Ste. Rictrude, the
30th at a position north of Boiry, the 56th at Achicourt, and
the 14th at Rouville. The two former were a considerable

(10134) G*

MEDICAL HISTORY OF THE WAR

Advanced dressing station at Henin. Ornamental work by orderlies.

Main entrance to an advanced dressing station in a dug-out at Henin.

. /

Road entrance to advanced dressing station in a dug-out at Henin.

THE BATTLE OF ARRAS, 1917

distance from the front line, some four or five miles, but the
two latter and the corps walking wounded collecting station
at Agny were within a short distance of the communication
trenches. A large corps rest station for the sick was formed at
Barly between Warlincourt Halte and Avesnes-le-Comte.

The casualties in the corps were comparatively slight on the
first day of the attack ; the numbers received into the field
ambulances being as follows between 6 a.m. of the 9th April
and 6 a.m. of the 10th April : —

Officers.

Other ranks

21st Division

.... 9

379

30th Division

396

56th Division

522

14th Division

553

Other formations

Germans

104

Total

2,043

The D.D.M.S. of the corps, Colonel Swan, visited all the
divisional advanced dressing stations, and corps and divisional
walking wounded collecting stations during the 10th April and
found them empty or practically empty, a fact which demon-
strated the ease with which these numbers could be cleared
from the battlefield by the general system of evacuation, which
had now become a routine operation after the experiences of
the Somme battles.

Until the 23rd April the work thrown on the medical services
of the Vllth Corps continued to be comparatively light. In
addition to the ten charabancs placed at his disposal by the
D.M.S. of the army, Colonel Swan had seventy lorries during
the first twenty-four hours from the corps, and was able to
clear all his walking wounded from Agny to Doullens, a distance
of twenty miles, with the greatest ease. For the clearing of the
main dressing station to the casualty clearing stations he had
No. 3 M.A.C. and a section of No. 31 M.A.C., the cars of which
were brought up to Gouy.

Both the corps collecting station at Agny and the main
dressing station at Gouy were moved forward on the 13th
April, the former to Mercatel and the latter to Boiry Ste. Ric-
trude, the corps rest station moving from Barly into the huts
left at Gouy by the main dressing station ; but, although sites
were being selected near Boisleux-au-Mont for the group of
casualty clearing stations at Warlincourt, the move to the new
site did not take place until after the battle. In view, however,
of the long distance of Warlincourt from the front, an advanced

(10134)

G**

MEDICAL HISTORY OF THE WAR

operating centre, as already noted, was opened towards the
end of April at the corps main dressing station at Boiry Ste.
Rictrude, but moved later into Nissen huts on the road from
Arras, near Ficheux. The field ambulance there was reinforced
by surgical teams and nursing sisters.

At this time the divisions of the Vllth Corps were preparing
for a renewed attack on the 23rd April. The 14th Division had
been relieved in the line by the 50th and the 30th by the 33rd
Division after the earlier fighting of the 9th to 11th April ; the
21st Division was also relieved and its front taken over by the
33rd Division on the 15th April, the corps then having three
divisions in the line. The 30th Division again came into line

Battle of Arras.
-Apr*j~ yn_ Corps Front ^ -/s/?-

if Caa/zg Maw Dressing Station. Q Pvsm-. Adv. D/Z£ssins Station. ACocas hULJONa hhoivoeoC<M-i~5TA.
***y.Af>fi>ao*af*ATc 3/&t/&h t-t/vec oh Apr.ii- ST.".

Scale of Mil.es

I O \ 8 3-^5
• + 4 1 1

on the 20th April, relieving the 56th Division ; and the attack
on the 23rd April was carried out by the 33rd, 30th and 50th
Divisions. The losses were only slightly heavier than in the
attack of the 9th April, the wounded received into the divisional
medical units being as follows during the twenty-four hours : —

33rd Division
30th Division
50th Division
Other formations
Germans

Officers. Other ranks.

34 551

23 529

52 896

3 71

2 56

Total

114

2,103

The corps main dressing station was capable of handling the
casualties without difficulty. It had been organized to deal
with 1,400 at a time, as well as to perform operations on and

THE BATTLE OF ARRAS, 1917

retain abdominal and other urgent cases. As on the 9th April,
the D.D.M.S. obtained a large number of lorries from the corps,
and these, together with 18 charabancs, were employed for

Collecting post for cars at St. Martin-sur-Cojeul, near Henin, 1917.

clearing the walking wounded collecting station. For clearing
the main dressing stations the D.D.M.S. had, as before, No. 3
M.A.C. and a section of No. 31 M.A.C.

Reception ward of advanced dressing station at Henin.

The 14th and 21st Divisions returned to the line in relief of
the 50th and 23rd Divisions after this action ; and the 18th
Division from the Fifth Army came into the corps area and

74 MEDICAL HISTORY OF THE WAR

relieved the 30th Division at the end of the month. The
casualties, however, were comparatively few after the attack
of the 23rd April, and there was little further to record affecting
the medical services on the Vllth Corps front.

The Medical Services of the Vlth Corps.

The Vlth Corps held a narrow front of some 2,700 yards from
the Cambrai road to the Scarpe, with the city of Arras behind
it. The attack on the 9th April was launched by the 3rd, 12th
and 15th Divisions, with the 37th Division and the 3rd Cavalry
Division ready to pass through and continue the preliminary
success. The chief problem in the medical preparations de-
pended on the fact that all traffic had to pass through Arras.
Consequently, it was anticipated that when the 37th and 3rd
Cavalry Divisions commenced to pass through it would not
be possible to get the wounded back to the casualty clearing
stations during the first thirty-six hours of the battle. There
were only two main roads leading from the town, the St. Pol
road on the north-west, and the Doullens road leading to the
Dainville-Warlus road on the west. Both these roads were
likely to be congested with the traffic entering the town.

The D.D.M.S. of the Corps, Colonel H. N. Thompson, there-
fore made special preparations for the retention of wounded in
what he designated advanced dressing stations, although in
reality they were equipped and manned to perform the functions
of main dressing stations, with the full resources of the field
ambulance tent divisions, supplemented by other material
specially obtained. They were established by each of the
divisions in caves, cellars and basements of buildings, protected
as strongly as possible with sandbags and overhead bursting
courses, on the north-eastern, eastern and south-eastern out-
skirts of the town. The chief of these was in a large subterranean
cave, from which stone had been excavated for building the
town in the 16th century. It was close to the 3rd Division
trenches and only 800 yards from the front line. Two inlets
for stretchers were tunnelled into it from the communication
trenches, and an outlet tunnelled out from the back into the
Rue St. Quentin, where an approach was constructed for ambu-
lance cars (see plan). This cave, to which the name of
' Thompson's Cave " was given, was fitted with electric light
and a piped water supply and was able to accommodate 700
wounded on stretchers in two tiers, together with dressing and
operating rooms, kitchens and latrines. It was manned by
field ambulances of the 3rd Division, but was in fact a corps

THE BATTLE OF ARRAS, 1917

dressing station for severely wounded requiring urgent attention.
Unfortunately on the 11th April a large shell exploded on the

Plan of "Thompsons Cave".
Battle of Arras, April 1917.

top of the cave and burst the water main, causing the roof to
fall in in two places. Although no casualties occurred, it was

MEDICAL HISTORY OF THE WAR

impossible to continue the use of the cave as a dressing station ;
and two new dressing stations were then opened in the town,
one in the Ecole Normale and the other in the Hopital St. Jean,
the latter becoming an advanced operating centre for abdominal
wounds with special surgical teams attached to it, until it too
in its turn had to be abandoned subsequently owing to shell fire.
Fortunately the congestion of the traffic in Arras did not delay
unduly the transfer of wounded from the dressing stations to
the casualty clearing stations at Agnez-les-Duisans.

Battle of arras.
-Ap-n//- 3^j Corps Front.
— i

- /9/7-

Q Adi> 'De£ss/NG Stat/on osz Aov. Post.
A Cax/zs IM\l.k;mg Woc/md£dCcu_i-. Pbsrr.
jg CoxpSMaw Do.£ss/^g Station.

A corps collecting station for walking wounded was prepared
in an extensive bomb-proof shelter of the bastion on the north-
west corner of the town. It could shelter some 450 wounded
at one time. Preparations were made in it for receiving,
recording, feeding and dressing the walking wounded as they
straggled in. Moats and a covered way bristling with guns
surrounded the bastion, and the hopes of clearing the wounded
by wheeled traffic from it were not promising. A duck-board
path leading to the Dainville road was consequently made
across the moats, and the wounded walked to the horsed ambu-
lance wagons and motor buses drawn up behind the artillery

THE BATTLE OF ARRAS, 1917

positions. The lightly wounded were thus conveyed to Warlus,
whence they were taken by light railway to Avesnes-le-Comte
and Frevent.

Pooling of Ambulance Cars. — Consequent upon the arrange-
ment by which the divisional dressing stations were formed
close to the communication trenches and the wounded taken
from them direct to the casualty clearing stations, there was
no normal zone of work for the motor ambulance transport of
divisional field ambulances. Colonel Thompson consequently
withdrew the motor ambulance cars from the field ambulances
and pooled them with the cars of No. 15 M.A.C. He employed

>•'

Trench entrance to advanced dressing station, Wancourt.

them in clearing the dressing stations in Arras to Agnez-les-
Duisans during the first phase of the battle. But when the line
of the Vlth Corps advanced, as it did by the 11th April, to some
five miles east of Arras, advanced dressing stations had to be
thrown out along the Cambrai road and the Scarpe valley
towards Bois-des-Boeufs, Feuchy Chapel and Feuchy, leaving
the tent divisions of the field ambulances as main dressing
stations in the original positions in Arras. When this occurred,
the D.D.M.S. restricted the work of the convoy to its normal
function of clearing the dressing stations in Arras, and ordered
the divisional ambulance cars to be restored to their units for
their legitimate work of clearing the advanced to the main
dressing stations. The disentanglement of the pooled cars,

78 MEDICAL HISTORY OF THE WAR

however, from the convoy proved not so simple as was antici-
pated, and there was much delay in clearing some of the
advanced dressing stations in consequence of the field ambulance
cars failing to return to their units at once.

This was specially so in the 37th Division, which attacked and
captured Monchy-le-Preux on the 11th April. At 4.30 p.m. the
A.D.M.S. of the Division was informed by the D.D.M.S. of the
Vlth Corps that his motor ambulance cars would be returned to
the division, and that No. 15 M.A.C. would in future only clear
the dressing stations in Arras. The division had advanced
dressing stations at Feuchy Chapel, full of wounded, in a con-
crete German aid post, and at Bois des Boeufs ; but no ambu-
lance cars had reached them since noon. There were no signs
of the cars at 9.45 p.m. and a telephone message to the D.D.M.S.
did not have any effect. A despatch rider was sent to the motor
ambulance convoy, followed by an officer at 10 p.m. urging the
return of the cars ; but it was not till 1.30 a.m. of the 12th April
that their arrival was reported to the A.D.M.S., when they were
at once sent forward to the advanced dressing stations.

The incident raises a tactical question of some importance in
the handling of the ambulance transport of medical units during
a battle. In order to employ the ambulance cars of field ambu-
lances in bringing back wounded from the dressing stations to
the casualty clearing stations, when they would otherwise have
been idle, was it necessary to pool them with the motor ambu-
lance convoy cars and place them under the officer commanding
the convoy ? Could they not equally well have assisted in
the work of clearing the dressing stations in Arras under the
direction of the A. Ds. M.S. of divisions and the officers command-
ing the units to which they belonged ? Had this course been
adopted the clearing of the advanced dressing stations thrown
out along the Cambrai road would have commenced auto-
matically under the divisional A.D.M.S. without his having to
wait for the disentanglement of his field ambulance cars from
the convoy and their return to the division.

Instances ol a similar nature occurred during the war. They
emphasized the importance of avoiding the practice of pooling
the field ambulance transport with that of motor ambulance
convoys, a practice to which the D.G.M.S. administrative staff
was consistently opposed.

Clerical Work at C.C.Ss. — Colonel Thompson made another
innovation in the work of his medical services during the battle.
He regarded the group of casualty clearing stations at Agnez-
les-Duisans as his corps main dressing station and attached to

THE BATTLE OF ARRAS, 1917 79

them a clerical staff from field ambulances of each of the
divisions for the purpose of recording the admissions, such
records being purposely omitted at the dressing stations in
Arras. The names and particulars of each wounded man
arriving at the casualty clearing stations were entered by this
staff in the small forms supplied for the purpose.* These were
periodically separated into bundles according to divisions and
sent to the A.D.M.S. of the division concerned, who had the
entries then made in the field ambulance admission and discharge
books. A similar staff of clerks was appointed to the corps
walking wounded collecting station, but the entries were made
there direct into the admission and discharge books.

Interchange of Equipment at C.C.Ss. — Special arrangements
were also made by Colonel Thompson for an interchange of
stretchers, blankets, hot-water bottles and such instruments as
artery forceps, between the dressing stations and the casualty
clearing stations by means of a check ticket system. Each
ambulance car driver handed in one half of a ticket with the
details entered on it of the articles brought back with the
patients, and obtained the corresponding number of articles on
handing in the second half to an issuing store on his returning
to the front.

These general arrangements in the Vlth Corps are of interest
and originality, and were undoubtedly advantageous in the
early phases of the battle, when the jumping-off place for the
divisions engaged was the town of Arras. Wounded were able
to reach the casualty clearing stations from Arras in some cases
within two hours of being wounded ; and there was considerable
saving of dressings and time. But as the front advanced the
tactical situation for the medical services became more normal
in character. Echelons of advanced and main dressing stations,
with separate zones of work for divisional and convoy motor
ambulance cars, were established in accordance with the
normal system of evacuation.

The Cavalry Advance to Monchy-le-Preux.

The operations of the Cavalry Corps, during the battle, as
affecting the medical services, centre in the work of the 3rd
Cavalry Division. This cavalry division moved to the north of
Arras at 10 a.m. on the 9th April preparatory to carrying on
the advance between the Scarpe and the Arras-Cambrai road

* A.F. W.3210.

80 MEDICAL HISTORY OF THE WAR

to the area beyond Monchy-le-Preux, while the 2nd Cavalry
Division followed up the advance south of the road and the
1st Cavalry Division the advance north of the Scarpe. The 3rd
Cavalry Division went into action on the following day, but
withdrew behind Arras again with few casualties. On the 11th
April its 6th and 8th Brigades again joined in the attack on
Monchy-le-Preux, and reached that village in support of the
attacks earlier in the day by the 37th Division. Towards
evening, as no further opportunity was given it for cavalry
operations, it was withdrawn, after suffering heavy casualties,
chiefly in the 10th Hussars and Essex Yeomanry of the 8th
Cavalry Brigade.

Two squadrons, however, of the 10th Hussars and part of the
8th Machine Gun Squadron remained in the village until relieved
on the night of the 12th/ 13th April. A regrettable incident
then occurred in connexion with the work of collecting the
wounded to the dressing stations further back.

In order to make intelligible the general disposition of the
medical services with the cavalry divisions during this action a
description of the organization of their field ambulances is neces-
sary, as it differed essentially from that of the field ambulances
of divisions. It will be recalled that during the advance to
the Aisne in 1914 most of the cavalry field ambulances were
organized as light and heavy sections, the former marching
with and attached to cavalry brigades, and the latter marching
behind the ammunition columns. When motor ambulance cars
replaced the heavy horse-drawn ambulance wagons at a later
period, this arrangement of light and heavy sections became a
definite organization, the light horsed ambulance wagons
remaining with the light sections and the motor ambulance
cars with the heavy section. The light section was organized
to provide an advanced dressing station, and the heavy section
a main dressing station, but some of the cavalry field ambu-
lances had prepared a special mounted section, the organization
of which was brought to the notice of the G.O.C. of the Cavalry
Corps, in a long memorandum by his D.D.M.S., Colonel F. J.
Morgan, in February 1917. The intention was that there should
be what he called a " pack mounted section " with each cavalry
field ambulance capable of affording aid to wounded during a
cavalry action on occasions when the whole resources of the

THE BATTLE OF ARRAS, 1917 81

cavalry field ambulance would not be available.* It was
anticipated that occasions might arise when cavalry would
advance through a gap rapidly and far, over a trench system
where ambulance transport could not follow, or when cavalry
regiments would be widely separated from such assistance as
could be afforded by cavalry field ambulances. The only
means then of removing the wounded would be by hand
carriage, and the " pack mounted section " was to carry along
with the advancing cavalry brigades stretchers, medical equip-
ment, water and blankets. These pack mounted sections
were intended to form brigade collecting posts in touch
with regimental medical officers, regimental aid posts, and
the on-coming light moving sections, and to keep wounded
collected in groups near roads until the state of the roads and
the military situation permitted their being cleared by the
light moving section ambulance wagons to the advanced
dressing station.

It was this organization of cavalry field ambulances that
went into action with the 3rd Cavalry Division on the 10th and

* Such a section for a British cavalry field ambulance was to consist of

2 officers, 10 mounted orderlies, 12 riding horses and 4 pack mules, each of

3 of the pack mules to carry 4 stretchers and 8 blankets, and the fourth
12 gallons of water in 6 petrol tins in 2 boxes, as well as medical comforts,
splints and dressings.

The pack mounted section of an Indian cavalry field ambulance was slightly
different, owing to the difference in its original organization. A mounted
section had for a long time been organized by the 5th (2nd Indian) Cavalry
Division, and consisted of 2 officers, 1 assistant surgeon, 20 other ranks, with
22 riding horses and 7 pack mules. Two of the pack mules were spare mules.
Two of the others carried two Miller-James wheeled stretcher carriers each,
a third rations and medical comforts, a fourth dressings and splints, and a
fifth water. Four special stretchers for mounting on the stretcher carriers
were constructed by removing the traverses and poles of the field stretcher
and inserting the latter when in use into slots in the canvas body, and keeping
them separate by a removable bar and ring traverses. The poles, when the
stretcher was not in use, were carried lance fashion in a bucket attached to
the stirrup of the mounted stretcher bearers, each of two bearers carrying a
pole, and one of them also the canvas and traverses. The 2nd Indian Cavalry-
Division ambulances had commenced this organization shortly after their
arrival in France, and it was after the Indian Cavalry Divisions had been
amalgamated with the Cavalry Corps as No. 4 and No. 5 (Indian) Cavalry
Divisions in September 1916 that the D.D.M.S. of the corps took up the
question of pack mounted sections as a definite war establishment for cavalry
some months later.

The composition, however, of the pack mounted sections varied according
to the views of the officers commanding cavalry field ambulances, and the
D.D.M.S. of the Cavalry Corps, just before the Arras operations, arranged
that the pack mounted section should be formed of a minimum of 2 officers,
1 N.C.O., 5 orderlies and 2 pack horse leaders, with 10 riding and 2 pack
horses. One of the pack horses was to carry 8 light jointed stretchers, and
the other 6 gallons of water in 3 petrol tins of 2 gallons capacity each, dressings
and medical comforts. Dressings and appliances were also to be carried in
saddle bags on the orderlies' horses.

82 MEDICAL HISTORY OF THE WAR

11th April. The following order was issued on the 8th April
by the General Staff of the division : —

" Medical Arrangements for ' Z ' day.

" (a) All heavy sections C.F.As. will remain concentrated at Gouy
under the orders of the A.D.M.S.

(b) Pack mounted sections will move with brigades under all
circumstances.

(c) Light sections C.F.As. will be collected as soon as the division
has carried out its first concentration, park just off the road in P. 12. a. 6. 6*
and await orders from the A.D.M.S.

(d) An advanced division dressing station will be established on the
main Arras-Cambrai road about Les Fosses Farm, N.ll.b.9.4,f when
the division moves forward to its first objective.

(e) Divisional collecting station for walking cases will be established
in the caves in Arras, where the Arras-Cambrai road runs into Arras."

On receipt of this order, which was attached to the divisional
orders of the same date at 11 a.m., the A.D.M.S. of the 3rd
Cavalry Division (Lieut. -Colonel D. Lawson) issued the following
R.A.M.C. Concentration Order No. 1, and Operation Order
No. 2 :—

" Medical Arrangements, 3rd Cavalry Division.
Concentration Order No. 1 .

1 . After zero hour -f- 2 on ' Z ' day the division will be standing to
at one hour's notice.

2. When the division moves one light ambulance wagon and a corporal
R.A.M.C. as wagon orderly will be detailed by each cavalry field ambu-
lance to accompany the regiments of its brigade on their march to the
eastern outskirts of Arras.

The wagon will follow closely after the rear regiment of the brigade,
will collect all casualties and take them to the dressing station in the
Grande Place, and then endeavour to pick up the brigade again.

At the railway crossing at the east outskirts of Arras the wagon will
return and park in some available sheltered spot just off the main road,
half-mile on the west side of Arras.

3. On the order to move being received the light sections in the order
No. 8 C.F.A., No. 6 C.F.A., No. 7 C.F.A., will follow the 7th Brigade
and park just off the road at the X road half-kil. N.N.E. of the X in
FOSSEUX (Lens 11, 1/100,000) and await further orders from the
A.D.M.S. Horses harnessed in but poles down.

Wheeled stretcher carriers will be kept ready for early use.

4. Combined heavy sections will remain in billets at Gouy ready to
move at half-hour's notice.

5. Motor ambulance cars will move independently from Gouy not
sooner than one hour after the light sections have moved and concentrate
with light sections.

6. A subsequent move forward will take place with a view to bringing
the division into a further position of readiness.

(a) In this move A.l Echelons of Brigades, the Division Ammunition
Column and A. 2 Echelons will move into the area vacated by
7th Cavalry Brigade.

* Between Fosseux and Wanquetin, and between eight and nine miles
west of Arras.

f Just south of Monchy-le-Preux.

THE BATTLE OF ARRAS, 1917 83

(b) As soon as the Divisional Ammunition Column followed by A.2
Echelon have moved off the light sections of C.F.As. in the
Older given will follow A.2 Echelon and move before the Mobile
Veterinary Sections.

7. Units will clear roads and villages as far as possible when halted.

(a) When any unit receives the order to move, it will warn the unit

in rear of it.

(b) As soon as the march is resumed all units will close up.

8. Zero hour is fixed at 5.30 a.m. on 9th April, Z + 2 = 7.30 a.m.
Issued at 1 a.m. 9.4.17."

" Medical Arrangements, 3rd Cavalry Division.
Operation Order No. 2.

8th April 1917.
Reference Map 51 B & C. (1/40,000).
Lens 11 (1/100,000).

1. Third Army is attacking east of Arras to-morrow. This attack
will take place at zero hour, to be notified later.

2. The Vlth Corps will assault the Wancourt-Feuchy line north and
south of the main Arras-Cambrai road at approximately Z + 8 hours.

Should this succeed the 37th Division will attack Monchy-le-Preux
and the ground north and south of it.

3. When Monchy-le-Preux has been seized the 3rd Cavalry Division
will advance on its first objective, the line Vis-en- Artois-Boiry Notre
Dame ; the 50th Infantry Brigade, 17th Division, will be following the
3rd Cavalry Division.

4. (a) 8th Cavalry Brigade will be moving north of Monchy to Boiry
Notre Dame.

(b) 6th Cavalry Brigade will be moving south of Monchy to Vis-en-
Artois.

5. (a) Pack mounted sections of cavalry field ambulances will
accompany their respective Brigade Headquarters.

The O.C., C.F.A. or O.C., Section will get in touch with regimental
medical officers as soon as practicable and deal with casualties, collecting
them in groups under any available shelter and near roads or tracks.

A series of relay posts is to be established along the main Arras-
Cambrai road, and casualties will be brought along that road and handed
over to nearest relay party.

(b) Light sections of C.F.As. will be concentrated in accordance with
attached concentration order No. 1 and be prepared to move off on
quarter-hour's notice to form an advanced dressing station under orders
from this office.

This dressing station will probably be in Les Fosses Farm, N.ll.b.9.4
on the main Arras-Cambrai road.

Light wagons will be sent out to get in touch with pack mounted
sections as soon as possible.

(c) Motor ambulance cars will move independently to the same con-
centration point as light sections, where they will be divisionalized under
charge of the senior M.T. N.C.O. and await further orders from the
A.D.M.S.

(d) The combined heavy sections, under command of Captain Slaney,
R.A.M.C, will remain concentrated at Gouy, and await further orders,
but be ready to move at half -hour's notice.

The O.C. combined heavy sections will be prepared to send forward
on quarter-hour's notice 2 Serjeants, 4 corporals, and 32 privates, R.A.M.C,
to act as stretcher bearers.

* Just north of the Arras-Cambrai road, about three miles from Arras.

84 MEDICAL HISTORY OF THE WAR

Seven motor ambulance cars will be sent to convey this party. It will
be formed into 8 squads, and each squad will carry 1 long stretcher,
1 blanket, and, if possible, 1 large water bottle or petrol tin of water.

(e) No. 12 Sanitary Section will remain at Gouy, and will be prepared
to follow combined heavy sections if so ordered.

6. The A.D.M.S. will be at H.32 central (51 B).*

7. All walking wounded from the division will be directed to the
Bastion collecting post, Arras. Lying and sitting cases will be taken
to the nearest infantry advanced dressing station or the ' Cave,' A.D.S.,
Arras.

Copy No. 1 to G.S. 3rd Cavalry Division.
No. 2 to ' Q *

No. 3 to D.D.M.S., Cavalry Corps.
No. 4 to File.

No. 5 to No. 6 Cavalry Field Ambulance.
No. 6 to No. 7
No. 7 to No. 8
No. 8 to O.C. Combined Heavy Sections."

Accordingly when the 3rd Cavalry Division advanced on the
10th April the pack mounted sections moved with brigade
headquarters. The casualties were few, and these sections were
able to deal with them. Stretcher bearer parties went out from
the light sections, but they were not required, and all returned
to the bivouacs west of Arras at 9 p.m.

On the 11th April the pack mounted sections again went
forward with their brigade headquarters, and at 12.30 p.m.
the stretcher bearer party was sent along the Cambrai road to
search the ground over which the cavalry had advanced. At
1.30 p.m. eighteen light ambulance wagons went forward to
Feuchy Chapel, where the stretcher squads had brought the
wounded, and where the 37th Division had an advanced
dressing station.

The remainder of the light sections of Nos. 6 and 8 Cavalry
Field Ambulances were sent out at 2.30 p.m. to form a dressing
station as far forward as possible, but were unable to get beyond
the Bois des Boeufs, three miles west of Monchy, where also
an advanced dressing station of the 37th Division had already
been established. The 3rd Cavalry Division order to form an
advanced dressing station at Les Fosses Farm on the Cambrai
road 1,000 yards south-west of Monchy-le-Preux could not be
carried out.

The D. A.D.M.S., Captain Newman, who had been sent for-
ward by the A.D.M.S. to form an advanced dressing station
with the light sections, visited brigade headquarters and saw
the Os.C. of No. 6 and No. 8 C.F.As. with their pack mounted
sections at 4.30 p.m. Heavy casualties were then known to be

*At the Bois des Boeufs, two and a half miles from Arras on the Cambrai
road.

THE BATTLE OF ARRAS, 1917 85

west of Monchy, but neither of them told him that they
required further assistance.

What followed is not very clear, but the A.D.M.S's. diary for
the 11th April records that the light sections of the cavalry
field ambulances were withdrawn with the division west of
Arras at 9 p.m. They were working under his direct orders,
and not under the orders of their commanding officers, who were
at the time with pack mounted sections at headquarters of
brigades. So far as the O.C. of No. 6 C.F.A. is concerned there
appears to have been little difficulty. He states that after
dusk on the 11th April stretcher bearers from the light sections
collected wounded from the line Monchy-le-Preux-Les Fosses
Farm, and evacuated them by the light ambulance wagons to
infantry dressing stations, and that by 9 p.m., before the last
regiment of the brigade was relieved, all casualties in the brigade
had been evacuated, when the brigade moved back to billets
on the racecourse west of Arras.

At 5.15 p.m. the following field message was issued by the
G.O.C. of the division : —

" The Division will withdraw west of Arras to-night. Wheels will
move by road and remainder of division by cavalry track and will
bivouac on the Champs des Courses (Ref. Lens 1/100,000) just west
of Arras. Order of march 7th Cavalry Brigade, 8th Brigade, 6th
Brigade, IVth Brigade R.H.A., C.F.As. A.i and A.ii echelons have
already received orders to move. Any portions of A echelons now
with units will move under the orders of those units. 6th and 8th
Brigades will not withdraw until relieved by units of the 12th Division.
IVth Brigade R.H.A. will remain in present positions until 7 p.m. when
they may withdraw. C.F.As. will only withdraw on completion of
evacuation of wounded of division. Supply sections will meet units on
arrival. 7th Brigade will allot bivouac areas. Divisional Report
Centre Zero exchange G.22.d.31."

At 5.55 p.m. the D.A.D.M.S. sent the following message to
the A.D.M.S. :—

" Impossible to open station at Les Fosses Farm. Am removing
infantry and cavalry wounded from Maison Rouge dressing station on
main road. Have sent forward stretcher squads to 6th and 8th
Brigades and have seen Heap* and Downie*. Believe there are many
casualties. Have also ambulance wagons on road just east of Feuchy
picking up wounded. Many wounded just west of Monchy cannot
be reached. Have no further information as to what is likely to
happen in near future but think advance improbable."

At 6.15 p.m. the D.A.D.M.S. again sent a message to the
A.D.M.S. to the following effect :—

" Attached withdrawal orderj is forwarded. I will remain here r untii
wounded of division are evacuated. Please send me another motor
cyclist in place of bearer. I will tell ambulance wagons to return here
until I consider work is completed. I think your office can remain in
Arras to-night. I am sending limbers back to Cavalry area Arras to-
await light wagons."

* Os.C. of No. 6 and No. 8 C.F.As. with the pack mounted sections,
f Field message of 5.15 p.m. as above.

10134) ■ h

86 MEDICAL HISTORY OF THE WAR

At 7 p.m. the pack mounted section of No. 7 C.F.A. reported
to the A.D.M.S. its arrival at the racecourse, but had nothing
further to note with reference to the day's action.

The O.C. No. 8 C.F.A. joined his pack mounted section in a
copse some 600 yards north-west of Monchy, where three of his
horses, including a pack horse, were killed and two others
wounded, rendering his pack section useless. He then came
back with the remainder and reported the situation to the
A.D.M.S. by a field message. About 5 p.m. he went into Monchy
to find out the position of the wounded. There he found Captain
Stork, the regimental medical officer of the Essex Yeomanry,
and also Major Cowie of the R.H.G., and having satisfied
himself of the position of the wounded he reported the facts to
the officer in charge of the stretcher bearer party and rejoined
his pack mounted section, returning with it at midnight to the
racecourse.

Neither the A.D.M.S , who ordered the withdrawal of the
light sections, nor his D. A.D.M.S., who was with them on the
Arras-Cambrai road and in touch with the advanced operating
centre, appears to have been aware that wounded of the 8th
Cavalry Brigade were still awaiting evacuation from Monchy,
and consequently there were neither pack mounted sections nor
light sections of the 3rd Cavalry Division nearer than the race-
course on the west of Arras during the night of the 11th/ 12th
April. The 12th Division was then taking over the front from
the 37th Division and moving into the advanced dressing
stations at Bois des Boeufs and Feuchy Chapel. The A.D.M.S.
first received information of wounded still being in Monchy from
the D. A.D.M.S. of the Cavalry Corps at 3 p.m. on the 12th
April, and at 6 p.m. of that day the D.A.D.M.S. of the corps
himself went to Monchy with a stretcher party, bringing back
the O.C. of the 10th Hussars and thirty other wounded during
the night of the 12th/ 13th, and reporting that some forty more
were in the cellars there. These were eventually got out the
following night by a large party of officers and dismounted men
and by motor ambulance cars which went forward to Feuchy
Chapel. About eighty wounded were brought back. Another
party went into Monchy on the night of the 14th/ 15th April,
but found only one cavalry wounded remaining there.

The bearers and transport of the field ambulances of the 12th
Division also helped to clear numbers of cavalry wounded out
of Monchy. The A.D.M.S. of the division was informed of the
wounded being there by the G.O.C. of the 3rd Cavalry Division
and by the G.O.C. of one of the brigades of the 12th Division

THE BATTLE OF ARRAS, 1917 87

at 4 p.m. on the 12th April. He then gave orders to No. 37
Field Ambulance and all the bearers of the division to continue
clearing Monchy-le-Preux until 6 a.m. on the 13th April. It
was not possible to carry on this work in daylight owing to the
approaches being under enemy observation and fire.

The fact of so many of the cavalry wounded having been left
in Monchy during the night of the 11th/ 12th April brought at
the time considerable criticism on the working of the medical
services. The chief cause appears to have been the want of close
touch between the A.D.M.S. and his divisional staff, from whom
he had no information of the conditions in Monchy at the time
the cavalry division was withdrawn. At the same time, as both
the officers commanding No. 6 and No. 8 C.F.As. and the officer
in charge of the bearer party seem to have known that there were
wounded in Monchy on the night of the 11th April, it is difficult
to understand why the information did not reach the A.D.M.S.
through them, although they may not have been aware of the
large number of wounded in Monchy or the urgency of clearing
them during the night, or may possibly have understood that
the 12th Division medical units, which were taking over the
area, would clear the battlefield, notwithstanding the fact that
the orders of the 3rd Cavalry Division made its field ambulances
responsible for clearing the wounded before they withdrew.

This incident brings out certain lessons regarding the em-
ployment of the medical services with cavalry. The occasion
was one of the very few on the western front when a cavalry
division went into action otherwise than as dismounted cavalry.
The chief lesson appears to have been the importance of a close
touch being maintained between the officers commanding the
cavalry field ambulances and the regimental medical officers in
front and the stretcher bearers, ambulance transport and dress-
ing stations behind. This duty was the duty of the officer
commanding the pack mounted section of the ambulance.
The O.C. of No. 8 C.F.A. had done what he considered necessary
by finding out the position of the wounded in Monchy-le-
Preux, getting in touch with the regimental medical officers
there, and reporting the facts to the officer in charge of the
'stretcher bearer party, but apparently concluded that he had
no further responsibility in bringing the wounded back. That
this was a correct estimate of his responsibility is doubtful.
The A.D.M.S. of the division had taken control of all sections
of the field ambulances except the pack mounted sections. It
is obvious, however, that he would not have permitted the
light sections to be withdrawn during the night of the 11th/ 12th

88 MEDICAL HISTORY OF THE WAR

April had he been informed of the situation. Neither his
D. A.D.M.S., who was with the light sections, nor the officer in
charge of the stretcher bearers, sent him this information, nor
was he told of it by the staff of the division. His position was
with what was known as A. echelon and not with the advanced
report centre ; and A. echelon appears to have remained
far back during the whole action. In fact the A.D.M.S. himself
went forward to Arras in order to be in closer touch with what
was happening, and was there when the orders for the final with-
drawal of the cavalry were issued. There was thus a want of
direct touch in two directions, one between the A.D.M.S. and
the staff of the advanced report centre, and the other between
the A.D.M.S. and the combined light sections of the cavalry
field ambulances which he undertook directly to control.
These facts come out fairly clearly from the documents and
orders, and show how unwise it is to dissociate the officei
commanding a cavalry field ambulance from the responsibility
of complete control of the whole of his unit during an action ;
and for the A.D.M.S. to be at the same time dissociated from
the general staff.

The fact, however, that there were large numbers of woundec
in Monchy after the 3rd Cavalry Division was withdrawn
appears to have been unknown at the advanced report centre
at the time. The D. A.D.M.S. was in touch with this centre
during the day, and no notice of these casualties reached him.

The incident had one good effect, for on subsequent occasions
the A.D.M.S. remained at the advanced report centre, and
attended all staff conferences. Previously he had not been
ordered to attend these.

The A.D.M.S. after the action reported to the D.D.M.S. oi
the Cavalry Corps that he had come to the conclusion, aftei
conversation with officers commanding his cavalry field ambu-
lances, that the pack mounted section was useless, and a waste
of officers, men and horses. As regards its equipment, the con-
tents of saddle bags were not used at all. He stated that the
cavalry could never have to work under harder conditions, and
it was therefore useless to carry these bags and their contents.
The stretchers being tied in a bundle on the pack saddle with
blankets necessitated the whole load being undone to get one
stretcher. In one case this resulted in all being left on the ground
owing to shell-fire. They were recovered later. The method of
carrying the water in petrol tins in boxes was a failure. The
horses had considerable difficulty in getting over the muddy
ground, and had to follow at a distance. The boxes were

THE BATTLE OF ARRAS, 1917

not strong enough, the petrol tins broke through them, and the
water was not used.

With regard to stretchers, there was considerable difficult y
in getting the poles through the canvas when the canvas got
wet and when working in a hurry. Besides, different parts of
the stretchers were being carried on two horses, and they might
not be together when the stretcher was wanted. The A.D.M.S.
also considered that eight stretchers were more than could be
used by the small number of men in the mounted section. He
suggested that instead of the pack mounted section, the best
plan would be to bring up about seventy-five stretchers and
blankets in the lorry of the divisional sanitary section, and

An advanced dressing station at St. Nicolas on the Arras Front.

after an action distribute them to men, obtained from regiments,
for collecting and removing the wounded.

The Medical Services of the XVIIth Corps.

The divisions of the XVIIth Corps, 9th, 4th, 34th and 51st,
fought on the line between Arras and the Vimy Ridge along
the Scarpe valley. The D.D.M.S., Colonel Kirkpatrick, had
formed a corps main dressing station with tent divisions of the
field ambulances at Haute Avesnes, where there were huts
erected by the French when they occupied the area in 1915.
These had been supplemented by tents and Nissen huts. Ad-
vanced dressing stations were prepared at St. Nicolas, St.
Catherine, the northern suburbs of Arras, and at Anzin

(10134) K*

MEDICAL HISTORY OF THE WAR

St. Aubin, three miles north-west of Arras, where a walking
wounded collecting station was also prepared. A corps
rest station was formed at Savy-Berlette near Aubigny.
Divisional rest stations were also formed for the division on
the left at Caucourt and for the division on the right at Ferme
Doffine. The Savy rest station was used generally by the corps,
but chiefly by the two central divisions, one in the line and
one in reserve. No. 24 M.A.C., placed at the disposal of the

Advanced Dressing Station at St. Nicolas
Battle of Arras, 1917.

D.D.M.S., was stationed between Aubigny and the Arras-St.
Pol road, a large reserve of blankets being stored with it.
Trollies for use on the light railway for bringing ammunition
and supplies to the trenches were adapted to carry back one
stretcher case each on the return journey.

Heavy artillery had unfortunately been placed close to
the walking wounded collecting station at Anzin, with the
result that two or three days later, on the 30th March, con-
siderable damage was done by an enemy shell which entered
the roof of the R.A.M.C. billet and exploded. Other shells also
fell near.

THE BATTLE OF ARRAS, 1917

Twenty buses or charabancs were placed at the disposal
of the D.D.M.S. for evacuating the walking wounded, the
intention being to take them back to No. 12 Stationary
Hospital, St. Pol. Empty lorries returning to railhead were also
to be used by the walking wounded.

The casualties were heavy on the first day of the battle. By
6 p.m. of the 9th April 111 officers and 2,065 other ranks were
collected. Evacuation proceeded so well, however, that the
main dressing station and the walking wounded collecting
station were practically clear then. From 6 p.m. of the 9th
April to 6 a.m. of the 10th 77 officers and 2,101 other ranks

Battle of Arras, April 19 17.
Scarpe Valley Operations.

were cleared. The attack had been launched by the 9th, 34th
and 51st Divisions ; the 4th Division passed through the 9th
Division and carried on the attack, capturing Fampoux the
same day. The wounded collected from 6 a.m. to 6 p.m. on
the 10th April were then comparatively few, 30 officers and
628 other ranks. The number of walking wounded was, as
anticipated, by that time small, and the chief congestion was in
the corps main dressing station. In order to assist No. 24
M.A.C. in clearing it, 15 cars of No. 31 M.A.C. were attached to
it by the D.M.S. of the Army.

On the 13th April the 51st Division on the corps left was
relieved by the 2nd Division of the XHIth Corps from the First

(10134)

H**

92 MEDICAL HISTORY OF THE WAR

Army, and Anzin then came into the First Army area. The
XVIIth Corps walking wounded collecting station was aban-
doned and divisional walking wounded stations formed further
in advance.

On the 14th April the 34th Division sector was taken over by
the 63rd (R.N.) Division, also of the Xlllth Corps, and the
XVIIth Corps front was shifted further south along the valley
of the Scarpe, the front line being held by the 4th and 51st
Divisions, with an advanced dressing station and walking
wounded collecting station at St. Nicolas, and main dressing
station as before at Haute Avesnes.

Street in St. Nicolas with ambulance cars. Battle of Arras 1917.

On the 20th April the 37th Division, which after the capture
of Monchy had been resting in the back area, relieved the 4th
Division, and its field ambulances took over the walking
wounded collecting station, the main dressing station and corps
rest station.

The 51st and 37th Divisions attacked on the 23rd April.
Up to 6 p.m. 36 officers and 1,027 other ranks were collected to
advanced dressing stations at St. Nicolas and east of St.
Laurent-Blangy, and 63 officers and 1,266 other ranks during
the succeeding twenty-four hours, the 51st Division being then
relieved by the 34th. The attack was resumed on the 28th
April, but with fewer casualties. For the subsequent operations
on the Arras front the D.D.M.S. arranged for petrol tractor
trollies to run between Athies and Arras on the light railway

THE BATTLE OF ARRAS, 1917

along the tow path on the north bank of the Scarpe. Three
trains carrying sixteen stretchers each were organized for this
purpose.

When the XVI I th Corps front had advanced to Roeux, six
pontoons were placed on the Scarpe between Fampoux and
Athies locks. They were coupled together in pairs, and worked
by the divisional R.E., each couple taking twelve stretcher
cases. They proved of the greatest assistance in getting back
severely wounded over the stretch of country between Fampoux
and Athies. The wounded were brought to Fampoux and Fam-
poux Lock by relays of stretcher bearers and wheeled stretchers.
From Fampoux itself they went back in ambulance cars and
from the lock in pontoons to Athies Lock, where they were
transferred to ambulance cars, and thence through a collecting
post at L'Abbayette and an advanced dressing station at

E>attle of- Arras

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St. Nicolas to the main dressing station at Haute Avesnes.
There was great difficulty in getting the medical units forward
owing to congestion of roads and the damage to roads by shell-
fire. Consequently much of the material was brought up on
pack horses.

The D.M.S. of the Third Army had estimated that the
greatest number of casualties would be on the XVI I th Corps
front, as it was much exposed to enemy fire, and provision had
been made, especially by the A. D.M.S. of the 34th Division,
for constructing regimental aid posts in dugouts according to a
standard plan (see plan). The greater part of the Third Army
front, however, north of the Scarpe was taken over by the
XHIth Corps of the First Army after the 12th April.

On the 30th April the A.D.M.S. of the 9th Division (Colonel
F. A. Symons) was killed when walking to his advanced dress-
ing station at St. Nicolas. The division had other heavy

MEDICAL HISTORY OF THE WAR

losses in its medical personnel, the medical officer of the 11th
Royal Scots, Captain T. W. Martin, and an officer of the
South African Medical Corps, Captain I. Welsh, and three other
ranks of the R.A.M.C. being killed en the 9th April; while
eight of the R.A.M.C. and four of the S.A.M.C, were wounded.
Notwithstanding the difficulties and dangers of this front
the general scheme for collecting and evacuating the wounded
to Haute Avesnes and thence to Aubigny worked smoothly

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The advanced dressing station at St. Nicolas
on the road to Roclincourt.

and well. It was more complicated than that of the
other corps of the Third Army, in consequence of the use
of pontoons and tramlines, and the difficulties of bringing
ambulance transport and material up through the congested
and broken roads of the Scarpe valley.

Weather.
The weather during the earlier days and some of the later
days of the battle was characterized by high winds, snow,
sleet and rain. Fortunately the means of shelter and the
accommodation for the wounded proved ample.

CHAPTER V.

THE BATTLE OF VIMY RIDGE.

THE operations leading to the capture of Vimy Ridge and
an advance eastward of it were carried out from the
9th April onwards by the First Army at the same time as the
Battle of Arras was being fought by the Third Army on its
right ; but only a portion of the First Army was engaged, and
consequently the number of casualties was not expected to be
so great as on the Arras front.

Cars coming from Lille Road collecting post during the
Battle of Vimy Ridge.

For some time before the attack the D.M.S., Surgeon-General
W. W. Pike, had been preparing for the battle in association
with Colonel Ross, the D.D.M.S. of the Canadian Corps, which,
with a brigade of the 5th Division, was to make the attack
on the 9th April. He had estimated the probable number of
casualties at 20,000 during the first three days and 10,000
during the following week.

The Medical Services with the Canadian Corps.

The regimental aid posts were in dugouts, and these had
been enlarged in many instances and greatly improved. The
trenches leading from most of them were widened to facilitate

MEDICAL HISTORY OF THE WAR

stretcher carriage, and arrangements were made to have
certain trenches allotted for the use of the wounded only.
Relay posts, along the line of hand carriage, were organized
back to the advanced dressing stations.

The advanced dressing stations were, as a rule, in deep
dugouts protected by steel or iron framework covered with
sand-bags or earth to a depth of several feet, constructed so as
to give good cover to the wounded and shelter for the R.A.M.C.

Roclincourt collecting post, showing snow
during the Battle of Vimy Ridge.

personnel. On the average each advanced dressing station
could take about thirty or forty lying down cases. Other
dressing stations were organized in cellars and basements of
breweries, some of which had shelter for 100 or more.

Evacuation to advanced dressing stations was in some
sectors by stretchers on trollies, and in a few cases by the horsed
ambulance wagons.

Four main dressing stations were prepared behind the front
of the attack, one at Ecoivres, another at Les Quatre Vents,
a third at Estree-Cauchie for sick only, and a fourth at Grand

THE BATTLE OF VIMY RIDGE

Servins. The main dressing station at Les Quatre Vents was
organized with three or four tent divisions of Canadian field
ambulances as a large corps main dressing station. It was
capable of taking about 2,000 wounded at one time, the
accommodation having been increased by forty marquees
before the battle.

In addition to these main dressing stations, two large collect-
ing stations for walking wounded were prepared, one at

-Apr*//-

Battle of Vimy Ridge.

Canadian Corps Front.

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—~—3*VT/SHf r /zoM7-L/M£.A*>*8' r .'' Scale of yards.

Villers-au-Bois, and the other at Chateau-de-la-Haie. The
walking wounded were brought thence by lorries to Hersin
and Coupigny, where they were retained and taken care of by
No. 13 Canadian Field Ambulance until they could be evacuated.
Roads and paths were flagged and arrow indicators placed
along them to guide the walking wounded to these collecting
posts, and also to the routes of lorries returning empty to
railheads. All these positions were in the Canadian Corps
area until the XHIth Corps took over the right of the Canadian
Corps on the 12th April. The dressing station at Ecoivres
then came into the XII Ith Corps area, wounded being evacuated

MEDICAL HISTORY OF THE WAR

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THE BATTLE OF VIMY RIDGE

from it to No. 1 Canadian and No. 24 Casualty Clearing Stations
at Aubigny.

The medical situation in the Canadian Corps is shown on the
map. The chief feature in the Canadian Corps arrangements
was the use of tram lines for clearing from the regimental aid
posts to the advanced dressing stations and still farther back.
All these arrangements had been very carefully and elaborately
organized.

The D.D.M.S. of the Corps had his headquarters at Les
Ouatre Vents. The 1st Canadian Division was on the right
with its A.D.M.S., Colonel Ford, at Ecoivres. It had two
advanced dressing stations, one at La Maison Blanche on the
Arras-Bethune road, south-west of Neuville St. Vaast, and the
other at Ariane at the cross-roads about one kilometre farther
south. The 2nd Canadian Division was on the right centre of
the attack with its A.D.M.S., Colonel Jacques, at Chateau d'Acq.
The advanced dressing station was at Aux Rietz. The 3rd
Canadian Division on the left centre had its A. D. M.S., Colonel
Snell, at Villers-au-Bois, and an advanced dressing station at
Neuville St. Vaast ; while the 4th Canadian Division on the left
of the attack had advanced dressing stations along thei\rras road
just south of Souchez, its A.D.M.S., Colonel Chisholm, being
at the Chateau-de-la-Haie.

A tramway line ran from Neuville St. Vaast to Aux Rietz,
and from there a light field railway went to what was known as
" Ambulance Corner," just south of Mont St. Eloy, where the
field ambulance cars were drawn up. As the road north of
Souchez was impassable the principal route of evacuation to
the main dressing stations was through Ambulance Corner and
Mont St. Eloy.

The A.Ds.M.S. of the Canadian divisions were each allotted
100 extra men from the divisional troops to act as stretcher
bearers and this greatly facilitated clearing the wounded back.

The number of wounded admitted to the field ambulances
from the commencement of the battle until the 8th May was
as follows : —

Division.

Officers.

Other ranks.

1st Canadian Division

2nd „

3rd „ „

4th „ „

5th Division
Corps Troops

147
110

119

3,926
2,808
2,166
2,659
1,415
278

Total

521

13,252

100

MEDICAL HISTORY OF THE WAR

THE BATTLE OF VIMY RIDGE

101

The majority of the walking wounded went to Coupigny and
Hersin, and the lying-down cases to Les Quatre Vents, whence
they were taken to the casualty clearing stations on the north
side of the Notre Dame de Lorette ridge and the back area.

The Medical Services with the Xlllth Corps.

Battle of Vimy Ridge.

6 ~ 1000 2000

Scale of yards.

x*""/-.£!!i Corps Front, -t&r-

4> Rs&.Aio oa. Coi-i-£c-r/Mo Post.

ft Adv Daz&ssihg Station.

A Walking Woumged CouLSCT./hsz

At the beginning of April the Xlllth Corps had been in the
First Army reserve with the 2nd, 31st and 63rd (R.N.) Divisions
in back areas in the neighbourhood of Pernes, St. Venant and
Busnes. It then moved to the right of the Canadian Corps and
took over the front line between the Scarpe and Vimy Ridge
on the 12th April, the medical units of the 2nd and 63rd
Divisions occupying posts previously held by divisions of the
XVIIth and Canadian Corps. A section of No. 14 M.A.C.
was placed at the disposal of its D.D.M.S., Colonel G. Cree,
at that time, and when the Corps was engaged in severe
operations against Oppy Wood on the 28th April, the whole
of this convoy was attached to it. No. 14 M.A.C. was then
stationed at Ste. Catherine.

The casualties of the Xlllth Corps were light, and there was
no special feature or difficulty in the evacuation of the wounded.

102

MEDICAL HISTORY OF THE WAR

The general arrangements of the medical situation during
this attack on Oppy Wood are shown in the following plan.

n — ._ Battle ofVimv Ridge.

diagram ofAULCorps Evacuation Organization April 1917.

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The Medical Services with the 1st Corps,

The 1st Corps was on the left of the Canadian Corps supporting
the Canadian attack by pressure against Lens. The main
dressing stations of the corps were in schools at Fosse 10 (Petit
vSains), Noeux-les-Mines, Bracquemont, Labourse and Bethune.
The arrangements generally were similar to those in the
Canadian Corps area, except that the trolly system of eva-
cuation was not so well developed.

The D.M.S. had arranged with the D.D.M.S. of the 1st Corps,
Colonel Westcott, to prepare a large walking wounded collecting
station with No. 73 Field Ambulance at Bracquemont capable
of accommodating 1,500 wounded at a time, near the railway
station there, and for temporary ambulance trains to run to it.

THE BATTLE OF VIMY RIDGE

103

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104

MEDICAL HISTORY OF THE WAR

There is no record, however, of its having been necessary to
bring ambulance trains up to this position.

In addition to these dressing stations for wounded, large
rest stations were available for the sick in the Canadian Corps
area at Fresnicourt, and in the 1st Corps area at Fouquieres and
Labeuvriere.

Bearers preparing the~ground for shelters at a
dressing station at Anzin.

The two divisions of the 1st Corps specially engaged in the
Vimy Ridge battle were the 46th and the 6th. They attacked
in the direction of Lens from Lievin and Loos on the 23rd and
24th April.

The A.D.M.S. of the 46th Division, Colonel W. Beevor, had
special difficulty in getting the wounded away during the day-
time on account of the enemy's artillery barrage along the lines
of evacuation, and many severely wounded had to be detained
by him in large cellars in Lievin during the day. In fact all
roads leading out of this suburb of Lens were extremely
dangerous. The nearest advanced dressing station for stretcher
cases of the 46th division was at the Cite Calonne, between

THE BATTLE OF VIMY RIDGE

105

Lievin and Grenay, with a main dressing station in a school at
Fosse 10 (Petit Sains), and a walking wounded collecting post
at Bully-Grenay, and also at Aix-Noulette.

The 6th Division medical posts were in and around Loos,
with advanced dressing stations at Maroc and Philosophe, and a
main dressing station at the Ecole Jules Ferry in Bethune. Its
walking wounded collecting station was at Mazingarbe.

Dressing station built into a bank and protected by sandbags at Anzin.

The following sketch map shows the positions of the medical
posts in the front area of this division.

Battle of Vimv Ridge.
Apt*;/- | sj Corps Front. -^/7-

^^ WaJ-KJNG h/cKJNOBD COL-L.. FbSTT.

106 MEDICAL HISTORY OF THE WAR

The Casualty Clearing Stations.

With the exception of those at Barlin and Bruay, the sites of
casualty clearing stations in the First Army were much the same
as during the battle of Loos, namely, at Merville and St. Venant
in the northern area, and at Bethune, Chocques, Lapugnoy,
Lozinghem and Lillers in the southern area. Fort Gassion,
at Aire, had been taken over by No. 39 Stationary Hospital.
No. 22 CCS. had been moved from Aire to Bruay, and No. 6
from Lillers to Barlin, while No. 7 was transferred from Merville
and opened in Bracquemont, the southern suburb of Noeux-
les-Mines, on the 21st April, in the hope that the road from
Souchez would be open then.

The casualty clearing stations had their accommodation
largely increased by tents, marquees and huts, and were
organized in separate sections for the reception of light and
severe cases respectively. Wounded from the right of the
attack were to be received in rotation by Nos. 6, 23, 18 and 22
Casualty Clearing Stations at Barlin, Lozinghem, Lapugnoy
and Bruay, and those on the left of the attack by Nos. 33, 58
and 1, at Bethune, Lillers and Chocques, 300 being taken to
each casualty clearing station in turn, with the exception of
No. 6 at Barlin and No. 33 at Bethune, which had to take in
severe cases for early operation at all times and which con-
sequently were only to receive from the convoys 250 at a time
These numbers, however, were subsequently found to be too
many, and were altered to 200 in the case of the casualty
clearing stations farther back, and 100 to 150 in the case of
No. 6 and No. 33.

Day and night signals were prepared at certain cross roads as
a guide to the returning ambulance cars, indicating which of
the casualty clearing stations was receiving. Indicators were
also placed warning the cars of holes in the roads and other
obstructions.

The seven casualty clearing stations receiving wounded from
the front of the attack were reinforced each by a surgical team
from the Fourth Army and from other casualty clearing
stations of the First Army, in addition to a team from a field
ambulance of each division of the First Army, consisting of 1
medical officer, 2 N.COs. and 8 other ranks. Emergency
stretcher bearers and others were obtained from the L. of C
and army troops. In this way the casualty clearing stations
that were receiving the wounded were reinforced by 41 medical
officers and 41 nursing sisters, of whom 14 of the former
and 34 of the latter came from outside the First Army. The

THE BATTLE OF VIMY RIDGE

107

reinforcements of other ranks of the R.A.M.C. were 29 N.C.Os.
and 128 other ranks, of whom only 7 were from outside the
First Army. Fifty-nine emergency stretcher bearers were
obtained from the L. of C. and 130 additional stretcher bearers
from the First Army troops.

Each casualty clearing station had from 100 to 150 beds
prepared on the same scale of equipment and comfort as beds
in a general hospital for the severer class of cases whom it
might be necessary to retain for several days before evacuation
to the base.

West Riding, No. 58, Casualty Clearing Station at Lillers.

The Motor Ambulance Convoys.
The motor ambulance convoys in the First Army at the time
were Nos. 2, 8, 12 and 13. No. 2, however, was employed in
the northern area and for entraining duties at Merville, St.
Venant and Aire. Of the remaining three convoys the D.M.S.
concentrated two of them, No. 13 and No. 8, at Barlin and
Labuissiere for clearing the Canadian Corps main dressing
stations, and No. 12 at Chocques for clearing the 1st Corps.

108 MEDICAL HISTORY OF THE WAR

He formed two reserve convoys of eighteen cars each from field
ambulance cars of divisions of corps not engaged. These
reserve convoys were parked in their corps areas ready to
move at an hour's notice. The convoys were supplemented
by lorries and motor buses, but the D.M.S. found the latter
unsuitable on account of roads and weather and made very
little use of them. No. 14 M.A.C. was transferred tem-
porarily from the Second Army and was at first concentrated
with No. 13 Convoy at Barlin. The Second Army also sent
ambulance cars on the 11th April from No. 5 M.A.C, but these
were returned a few days later.

The D.M.S. of the Army kept the convoys under his direct
control, as had been the custom in the First Army, but after
the capture of Vimy Ridge and when the Xlllth Corps took
over the right of the First Army, a section of No. 14 M.A.C.
was placed at the disposal of its D. D.M.S., and eventually the
whole of the convoy was placed under his control on the 26th
April. At the same time No. 31 M.A.C. was attached to the
Canadian Corps until the 26th April, when two of its sections
were withdrawn to work with No. 8 M.A.C.

The main dressing stations were all on the southern part of
the Notre Dame de Lorette ridge which ran east and west from
Souchez and Mont St. Eloy to the Bruay-St. Pol road with a
steep descent to the Flanders plain on its northern side. Con-
sequently the motor ambulance convoys had to cross this ridge
and descend by steep roads to Barlin and the other casualty
clearing stations. The route selected was by way of Verdrel, a
better and shorter route by way of Hersin being considered
unsafe owing to hostile artillery fire. The direct road through
Souchez was impassable.

Evacuation of Casualties.

The arrangement for ambulance trains was to garage five
ambulance trains and two tempoiary ambulance trains daily
in the army area, and to run the temporary ambulance trains to
Hersin for evacuating the walking wounded collected there and
at Coupigny.

The whole of the arrangements worked smoothly and well,
and there was never at any time congestion in the area. The
number of casualties in the first forty-eight hours was very
much less than was anticipated, the admissions to the field
ambulances up to 9 a.m. on the 11th April being 798 sick and
6,570 wounded. During that period ^1,032 sick and 5,912
wounded were evacuated from the army area by nine

THE BATTLE OF VIMY RIDGE 109

ambulance trains and three temporary ambulance trains,
the latter taking away 2,486 from Coupigny alone. There were
then left in the army area in field ambulances and clearing
stations only 1,126 wounded and 1,686 sick. A few of the sick
and wounded were also evacuated from the army area by
ambulance cars, lorries, buses and barges to St. Omer, but the
numbers were extremely small, only 15 wounded going back by
ambulance car, 151 sick and 2 wounded by lorries, 96 wounded
in buses, and 60 in barges.*

In the twenty-four hours from 9 a.m. on the 11th to 9 a.m. on
the 12th April only 802 wounded were admitted to the field
ambulances, and from that date to the morning of the 23rd
April, during a period of comparative quiet, the number
of wounded was 5,053, including 217 officers. The total
number of wounded from 9 a.m. on the 9th April to 9 a.m. on
the 23rd April amounted to 12,425, including 433 officers.
The number of sick admitted during the same period was 8,145,
including 291 officers.

During this period of comparative quiet, f constant work was
carried on in improving the roads and in arranging for the use
of trollies on tram lines.

On the 23rd April there was severe righting in the 1st Corps
from the direction of Lievin and Loos, and in the XHIth Corps
against Gavrelle, the number of wounded received during the
twenty-four houis from the commencement of the attack being
96 officers and 1,711 other ianks. The fighting continued
during the subsequent four days, but the casualties were then
comparatively few, the total number of wounded admitted
from 9 a.m. on the 23rd April to 9 a.m. on the 28th April being
181 officers and 3,323 other ranks.

The casualties amongst the medical services were severe.
Between 9th April and 8th May the losses in the R.A.M.C,

* Nos. 2 and 5 Ambulance Flotillas were mobilized in anticipation of the
battle. They had been demobilized during the winter months, when there
was little fighting in the army area. The barges were being run in pairs,
with one tug to two barges, but this was found unsatisfactory as if there was
any wind they could not be steered properly. There was also the disadvantage
of its being necessary to retain them at the loading point until 60 severe lying
down cases suitable for conveyance by barge were waiting transfer irom the
casualty clearing stations. The D.M.S., therefore, arranged with the officer
in charge of the flotillas at St. Omer to send up barges singly with as many
tugs as he had for the purpose, and, although he had only six tugs available,
the work was afterwards done better and cases were sent down more
expeditiously than when the barges worked in pairs.

t Bethune was twice shelled during this time. On each occasion the
patients in No. 33 CCS. were placed in cellars, and no casualties occurred.

110

MEDICAL HISTORY OF THE WAR

Canadian and 63rd (R.N.) Division medical services were as
follows : —

Killed.

Wounded.

Died of
Wounds.

Total.

Off.

O.R.

Off.

O.R.

Off.

O.R.

Off.

O.R.

R.A.M.C.
C.A.M.C.

Royal Navy

4
5

72
78
34

—

9
5

89
88
41

Total

184

—

218

It is of interest to note the number of wounded during the
first five days of the battles of Arras and Vimy Ridge in the
First and Third Armies, for comparison with the estimates made
in preparation for them. The actual numbers, day by day,
from 9 a.m. on the 9th April to the evening of the 13th April,
as reported to the D.G.M.S., G.H.Q. were as follows : —

First Army.

Officers.

Other
ranks.

Germans.

9 a.m. 9th to 9 a.m. 10th

9 a.m. 10th to 9 a.m. 1 1th

9 a.m. 11th to 5 p.m. 11th

5 p.m. 11th to 9 a.m. 12th

9 a.m. 12th to 5 p.m. 12th

5 p.m. 12th to 9 a.m. 13th

9 a.m. 13th to 5 p.m. 13th

113

72
15

9
22
19

2,518
3,867
298
452
432
364
299

158

404

Totals from 9 a.m. 9th to 5 p.m. 13th. .

258

8,230

631

Total

8.488

THE BATTLE OF VIMY RIDGE

Third Army.

Ill

Officers.

Other
ranks.

Germans.

6 a.m. 9th to 6 a.m. 10th

6 a.m. 10th to 6 p.m. 10th

6 p.m. 10th to 6 a.m. 11th

6 a.m. 11th to 6 a.m. 12th

6 a.m. 12th to 6 p.m. 12th

6 p.m. 12th to 6 a.m. 13th

6 a.m. 13th to 6 p.m. 13th

445
75
71

168
31
42
44

9,719
1,934

466
3,753

638
1,394

590

355

246

273

460

Totals from 6 a.m. 9th to 6 p.m. 13th. .

876

18,494

1,376

Total

19,370

The total in the two Armies, therefore, was 27,858. The
D.G.M.S. estimate of ambulance train requirements during the
first five days was approximately for 37,000 wounded, so that
there was a good margin of safety in the preparations, although
this margin would probably have been much less had the
retreat to the Hindenburg line not taken place before the
battles.

The wounded collected during the first seven days, i.e., to
9 a.m. on the 16th April, were, in the Third Army, 1,040 officers,
22,795 other ranks, and 1,108 Germans ; and in the First Army,
294 officers, 8,867 other ranks, and 620 Germans, or a total
approximately of 34,700, as compared with the preparatory
estimate for the first seven days of 44,000.

The activities on the Arras and Vimy front died down during
May, although considerable pressure was maintained against
the whole of the enemy's line from Lens southwards. The
Third Army was then beginning to extend its front to the Somme
in order to set free the Fifth Army for active operations in the
Ypres Salient.

CHAPTER VI.

THE FLANDERS OFFENSIVES IN 1917.

THE offensive operations in Flanders, which were to take
place after the battles of Arras and Vimy Ridge, com-
menced in June with the attack on and capture of the whole
of the Messines-Wytschaete ridge and the advance of the
British line a distance of 2J miles in the centre of the attack,
to a new line southwards through Klein Zillebeke from the
Ypres Salient to the neighbourhood of the Lys west of
Warneton.

Changes in Army Areas.

During the preparations for the main offensive which was to
follow, the areas and composition of the British armies in France
and Flanders underwent extensive readjustment. The coast
area between Dunkirk and Nieuport previously occupied by
French troops was taken over by the British. The XVth Corps
was detached from the Fourth Army in June and became an
independent command directly under G.H.Q. in this area, but
early in July the Fourth Army headquarters moved to Malo-
les-Bains, the eastern suburb of Dunkirk, and took over the
command.

The Fifth Army headquarters moved to Flanders during the
second week in June and took over the Ypres Salient from the
Second Army.

The Third Army then extended its front southwards by
taking over the areas previously occupied by the Fourth and
Fifth Armies. Its front area was thus facing the Hindenburg
line from Arras to the vicinity of Epehy and Ronssoy, and
continuous pressure was maintained against this line while the
preparations for the Flanders offensive were being made. The
Third Army headquarters moved from St. Pol to Albert.

The First Army also continued to attack the enemy both
north and south of Lens and reached the outskirts of that town.

The Second Army remained in its original area until after
the Battle of Messines, when, as noted above, its left sectors
in the Ypres Salient were taken over by the Fifth Army.

THE FLANDERS OFFENSIVES IN 1917

113

The Changes in the Medical Situation of Armies.

These preparations involved considerable changes in the
strategical position of the medical units. With the exception
of the divisional sanitary sections, which remained in sanitary
areas in accordance with the policy adopted earlier in the year,
the divisional medical units accompanied their divisions to
new areas.

Many of the casualty clearing stations, motor ambulance
convoys, advanced depots of medical stores, and mobile
laboratories of the Fourth and Fifth Armies remained where

Rest area for field ambulance near St. Omer.

they were when the headquarters of these armies moved to
Flanders. They came then under the control of the D.M.S. of
the Third Army. Others were moved to the Ypres and Dunkirk
areas.

After these moves had taken place in June and July the
D.M.S. of the Third Army had eighteen casualty clearing
stations, including the Indian, at his disposal, situated
as follows : —

Lucknow . .

No. 38

Nos. 21 and 48
Nos. 5 and 55

at Peronne la Chapel-"^

lette
at Bray
at Ytres
at Tincourt

From
4th Army.

(10134)

114

MEDICAL HISTORY OF THE WAR

No. 56

Nos. 45 and 49
Nos. 3 and 29
No. 9

Nos. 20 and 43
Nos. 30 and 42
Nos. 19 and 8

at Edgehill
at Achiet le Grand
at Grevillers
at Aveluy

at Boisleux au Mont

at Aubigny

at Agnez-les-Duisans

[_ From
f 5th Army.

He had also the following stationary hospitals :-
No. 6 . . . . at Frevent

No. 12 . . . . at St. Pol

No. 3 Canadian . . at Doullens Citadel
No. 41 . . . . at Gailly

Rest area for field ambulance near St. Omer.

The casualty clearing stations at Peronne-la-Chapellette,
Colincamps, Varennes, Warlincourt Halte, Avesnes, Doullens,
Gezaincourt and Boubers-sur-Canche had been closed, and apart
from the single units at Bray, Edgehill and Aveluy, and the
Indian CCS. at Peronne-la-Chapellette, the casualty clearing
stations were in groups of two at Ytres, Tincourt, Achiet-le-
Grand, Grevillers, Boisleux au Mont, Agnez-les-Duisans and
Aubigny. The last group, however, was handed over to the
First Army towards the end of August, thus reducing the
number of casualty clearing stations in the Third Army to
sixteen.

THE FLANDERS OFFENSIVES IN 1917 115

Seven motor ambulance convoys were left with the Third
Army, namely Nos. 3, 15, 16, 30, 21, 27 and 36. Five bacterio-
logical, three hygiene laboratories, and six advanced depots of
medical stores also remained with this army.

There were practically no changes at first in the positions
of the medical units of the First Army ; but in Septembef
and October, Surg. -General H. N. Thompson, who had
succeeded Surg. -General Pike as D.M.S. of the Army in
July 1917, when the latter was sent on special duty to East
Africa, commenced moving casualty clearing stations to two
advanced positions, under canvas, the one at St. Aubin, two
and a half miles north-west of Arras, and the other in open fields
on the Ruitz-Houchin road, west of Barlin. The casualty
clearing stations at Barlin and St. Venant, which had been
subjected to bombing from the air, were moved to these new
positions. The Ruitz site was deliberately chosen as being at
some distance from the railway line and other places likely to be
shelled or bombed by the enemy. Aire ceased to be a casualty
clearing station centre in May, when a stationary hospital,
No. 39, took the place of the casualty clearing station in Fort
Gassion.

Up to the time when the Fifth Army took over
the Ypres Salient, the Second Army medical units were
unchanged. In preparation for the Battle of Messines the
D.M.S. , Surg.-General R. Porter, whose headquarters were in
Hazebrouck, had grouped four casualty clearing stations at
or near Bailleul (No. 2, and No. 1 Australian in the town, No.
53 on the northern outskirts, and No. 11 at an ambulance train
siding on the main line where the railway crossed the Armentieres
-Bailleul road), four at Remy Siding (Nos. 2 and 3 Canadian,
No. 10 and No. 17) and two at Mendinghem near Proven (Nos.
46 and 12). There were single units at Trois Arbres (No. 2
Australian), Monts des Cats (No. 50), and Hazebrouck (No. 15).
The motor ambulance convoys with the Second Army were
No. 4 at Proven, No. 5 and No. 14 at Bailleul (the latter on
return from the First Army on 20th May), No. 1 1 at Poperinghe,
and No. 22 at Hazebrouck. The advanced depots of medical
stores were No. 2, No. 11 and No. 2 Canadian at Bailleul,
Hazebrouck and Remy Siding respectively, and there were
three bacteriological and one hygiene laboratory in the army
at this period.

After the Messines battle the groups of casualty clearing
stations at Remy Siding and Mendinghem came under the
adminstrative control of the Fifth Army.

(10134) k

116 MEDICAL HISTORY OF THE WAR

Owing to severe shelling of Bailleul in July and bombing
of Hazebrouck in September, casualty clearing stations in these
towns were closed. Those at Bailleul, except No. 53, which
remained in the asylum north of the town, were moved to
Oultersteene, three miles south-west of Bailleul, and to Gode-
waersvelde, while the casualty clearing stations and stationary
hospital at Hazebrouck were transferred to Ebblinghem, halfway
between Hazebrouck and St. Omer. Oultersteene then had
two casualty clearing stations, No. 2 and No. 1 Australian, and
Godewaersvelde three, Nos. 11, 41 and 37, the last having
been transferred in July from Avesnes le Comte in the Third
Army area.

The medical preparations which were made for the
Fifth Army behind Ypres were of an extensive character,
and every medical unit that could be spared was demanded by
its D.M.S., Surg.-General Skinner, and sent to him. In addition
to the groups of four casualty clearing stations at Remy Siding
and the two at Mendinghem taken over from the Second Army,
new groups were formed at Brandhoek, Dozinghem and
Bandaghem in June, after the arrival of the Fifth Army head-
quarters in the area.

Dozinghem and Bandaghem were fancy names, similar to
Mendinghem, given to new sites in open ground near broad
gauge railway lines ; the former three miles north of Poperinghe
in a clearing of the woods between Lovie Chateau and the
convent north-east of it ; and the latter in fields about one
mile south of Rousbrugge-Haringhe and some six miles north-
west of Poperinghe. The site for the group at Brandhoek was
close to the Ypres-Poperinghe main road about two and a half
miles east of Poperinghe and between the road and the railway
line. Nos. 4, 47 and 61 Casualty Clearing Stations were trans-
ferred from Varennes and Edgehill to Dozinghem ; Nos. 62 and
63 from Doullens and Boubers-sur-Canche to Bandaghem, and
Nos. 32, 44 and 3 Australian to Brandhoek from Warlincourt,
Puchevillers and Grevillers respectively. No. 13 CCS. was also
transferred to the Fifth Army in August, but after being brought
to Remy Siding and then to Mendinghem was not definitely
opened until brought to a back area near Arneke four miles
north-west of Cassel at the end of September. Surg.-General
Skinner was thus provided with sixteen casualty clearing
stations.

He was given five motor ambulance convoys, four being
transferred to him from other armies, No. 4 at Proven from the
Second Army, No. 31 and No. 24 from the Third Army, and

THE FLANDERS OFFENSIVES IN 1917 117

No. 20 from the Fourth Army. The fifth convoy, No. 6, was
brought up from Beauval when the Fifth Army moved to
Flanders.

Three advanced depots of medical stores were transferred to
the Fifth Army, No. 2 Canadian at Remy Siding from the
Second Army ; No. 18 to Dozinghem from the Third Army and
No. 31 to Proven from the L. of C. No. 19 which had been
brought up from Peronne-la-Chapellette in July to the Second
Army and opened at Godewaersvelde was also transferred to the
Fifth Army in October and placed by the D.M.S. in Poperinghe.

Three mobile bacteriological laboratories were transferred,
one each from the Second, Third and Fourth Armies, and a
newly formed mobile hygiene laboratory, No. 23, was also
sent to the Fifth Army and placed at Poperinghe. An additional
mobile bacteriological laboratory, No. 17, was transferred from
the Second Army in October.

A number of divisional sanitary sections proportionate to the
size of the army area and the divisions in it were allotted to
sanitary areas. Most of these were taken over from the Second
Army in the areas over which they were carrying on sanitary
duties at the time the Fifth Army came up to Flanders.

The Fifth Army was thus exceptionally well provided with
medical units under the control of the D.M.S.

When the XVth Corps took over the Dunkirk-Nieuport
area it had three divisions, the 1st, 32nd and 66th.
Two casualty clearing stations, No. 1 Canadian and No. 24,
were then transferred with it from Aubigny, and opened in
fields near Oosthoek, on the railway line about one mile east
of Adinkerke; the former unit occupied huts of a voluntary
hospital, which had been working with the French in that
locality. The staff of the voluntary hospital followed the French
troops to Roosbrugge, and were given huts there by the British
\ in exchange for those left by them at Oosthoek.

In July two more divisions, the 49th and 33rd, came into the
area, and three casualty clearing stations, Nos. 36 and 39 from
Peronne-la-Chapellette, and No. 34 from Tincourt, were then
transferred to the coast area. No. 39 was added to the group
at Oosthoek, while Nos. 36 and 34 were opened in part of a
large modern sanatorium on the shore at Zuydcoote. The
greater portion of the building continued, however, to be used
as a hospital by the French Medical Service, which remained
there after the French troops had left the area.

The Belgians had a large hospital at La Panne under the
direction of Dr. Depage, whose surgical work had frequently

118 MEDICAL HISTORY OF THE WAR

come under the observation of the British consulting surgeons.
He had a large staff of nursing sisters, some of whom were
English, and arrangements were made for the more urgent and
severe cases of wounds to be sent to this hospital. An officer
of the R.A.M.C. was attached to it for the purpose of discipline
and maintenance of records.

Two motor ambulance convoys, Nos. 26 and 10, a mobile
bacteriological and a mobile hygiene laboratory, and an advanced
depot of medical stores, were transferred from the Somme area
to the coast and distributed to Malo-les-Bains, Zuydcoote and
Oosthoek.

Malo-les-Bains, a sea-side suburb east of Dunkirk, was the
headquarters of the XVth Corps until the Fourth Army Head-
quarters arrived. The corps headquarters then moved forward
to Bray Plage. The building at Malo-les-Bains occupied by the
XVth Corps headquarters office was wrecked on the 27th June
1917 by a long distance enemy shell, and the headquarters
had moved to a large hotel on the sands further east. The
coast area remained under the command of the Fourth
Army from the 8th July until the 4th November, when the
XVth Corps was withdrawn, and the area again handed over to
French troops.

Outline of the Offensive in Flanders in 1917.

During the period June to November 1917 the offensive in
Flanders was carried out in a succession of carefully prepared
attacks by the Second Army in June against the enemy's
positions on the Messines-Wytschaete Ridge ; by the Fifth
Army in association with the French troops at the end of July
and during August against the positions in the Ypres Salient ;
by the Second and Fifth Armies in September, and by the
combined Second, Fifth and French troops in October and
November until active hostilities ceased in Flanders in the
middle of the latter month.

In the Dunkirk area no active offensive was undertaken,
but preparations were being made, during the time it was occu-
pied by British troops, for combined operations with the Navy
on the enemy's flank between Nieuport and Ostend, whenever
the operations in the Ypres Salient afforded a suitable oppor-
tunity.

The Fifth Army headquarters left Flanders for the Somme
area on the 14th November. The Second Army headquarters
left at the same time for Italy, and were replaced by the Fourth

THE FLANDERS OFFENSIVES IN 1917 119

Army headquarters, the designation of the army in the Ypres
Salient being changed on 20th December from Second Army
to Fourth Army.

The Medical Arrangements.

The general details of the medical arrangements for these
battles were similar to those described in the previous battles,
more especially those of Arras and the Vimy Ridge ; but some
important new features were introduced. Measures to deal
with mustard gas, which was used by the enemy for the first
time, were introduced. Surgical cleansing of wounds before
evacuation to the base became the established method of
treatment at casualty clearing stations, and the principle of
retaining so-called shell shock cases in a casualty clearing
station especially organized for their treatment in as advanced
a position as possible was adopted in the Fifth Army.

These influenced to a very great extent the medical arrange-
ments before and during the Flanders offensives in 1917 ; and
it is chiefly in connection with them that the medical work of
the battles differed from that of the previous battles.

CHAPTER VII.

THE BATTLE OF MESSINES.

THE battle of Messines was fought by the divisions of the
Ilnd Anzac, the IXth and Xth Corps under the Second
Army command. It commenced at ten minutes past three on the
morning of the 7th June without previous bombardment by the
explosion of nineteen large mines simultaneously beneath the
enemy's defences followed by an attack by the troops under a
creeping artillery barrage. The scheme of operations had been
carefully prepared. One objective line after another was seized
according to plan, the final objective being reached in the
evening. The new line was then consolidated and with the
exception of operations carried on to maintain the line against
counter attacks the active offensive ceased.

The General Medical Arrangements.

The general arrangements for the medical services were
prepared with the same amount of care and detail as those foi
the attack.

The A.Ds.M.S. of divisions were made responsible for clearing
the wounded from the firing line to the corps main dressing
stations and corps collecting posts ; the D.Ds.M.S. of corps for
clearing from these posts to the casualty clearing stations ;
while the D.M.S. of the army co-ordinated the clearing of the
casualty clearing stations to the lines of communication.

Regimental Aid Posts. — With regard to the work of the
A.Ds.M.S. arrangements in most of the divisions had been made
for eighty men to be kept as stretcher bearers in reserve at
the advanced headquarters of each brigade, and supplies of
stretchers were kept at regimental aid posts for them. Most of
the regimental aid posts were connected by trench tramways
with advanced dressing stations, and the majority of the
wounded were brought down by these. The regimental aid
posts had been increased in number and size, and strengthened.

Advanced Dressing Stations. — The majority of the advanced
dressing stations were situated near a narrow gauge field railway
which had been constructed along the whole front.

vMendinghem
PROVE*

BATTLE OF MESSINES JUNE 1917.

GENERAL SITUATION OF MEDICAL UNITS, SECOND ARMY.

Scale of Miles
J i 2-

+ Rea~mntl. Aid Post. Q Advanced Dressing Station or Collecting Post A Walkg. Wnded. Coll. Post.

Q Main Dressing Station A Cas. Cu

Motor Amb. Convoy O Adv. Depot Medical Stores.

ARMENTIERES

Malby&Sons.Lith.

THE BATTLE OF MESSINES 121

The five advanced dressing stations of the Ilnd Anzac Corps
were, roughly, from 1,700 to 2,700 yards behind the firing line,
those of the IXth Corps some 1,500 to 2,500 yards, and those
of the Xth Corps from 2,000 to over 4,000 yards, the farthest
back being an advanced dressing station at Dickebusch.

A divisional collecting post of the Xth Corps, which had been
established mainly for walking cases, was some 6,000 yards
from the firing line, the walking cases being evacuated to it by
the narrow gauge railway line.

Main Dressing Stations. — Two main dressing stations of the
Ilnd Anzac Corps were respectively some 7,000 and 5,500
yards behind the firing line. Those of the IXth Corps at
Dranoutre, Locre and Westoutre, 5,500, 6,000 and 8,000 yards
respectively, and those of the Xth Corps at La Clytte road and
Brandhoek, 6,500 and 10,200 yards. All of them were equipped
with seven special sets for giving oxygen to gassed cases.

Large numbers of the slighter cases and of the lightly wounded
were transferred direct from them to divisional rest stations.

Motor Ambulance Convoys. — A motor ambulance convoy was
allotted to each of the corps by the D.M.S. for the evacuation
of the seriously wounded from the main dressing stations to the
casualty clearing stations. For the conveyance of lightly
wounded to the casualty clearing stations thirty lorries were
placed at the disposal of each corps D. D.M.S.

Casualty Clearing Stations. — The casualty clearing stations to
which the wounded were evacuated were Nos. 46 and 12 at
Mendinghem, Nos. 10 and 17 and Nos. 2 and 3 Canadian at
Remy Siding, Nos 2, 8 and 53 at Bailleul, No. 11 on the railway
line south of Bailleul, and No. 2 Australian at Trois Arbres, or
eleven in all ; but the groups of casualty clearing stations at
Remy Siding and Mendinghem were transferred to the Fifth
Army at noon on the 10th June, and No. 11 CCS. was closed
on the 9th June owing to the enemy shelling its position at the
ambulance train siding with long range high explosive shells.
During the three days in which it was receiving wounded a
total of 4,210, chiefly walking wounded, were brought to it.

Each of the casualty clearing stations had been expanded to
accommodate 1,000 wounded, and had been reinforced by
extra personnel two days before the battle. Additional
operating tables and at least 100 fully equipped hospital beds
had been provided in each. The additional personnel at each
of the eleven casualty clearing stations were three surgical
teams, three additional medical officers, from six to twelve

122 MEDICAL HISTORY OF THE WAR

additional nursing sisters, and twenty other ranks of the
R.A.M.C. The surgical teams were obtained from casualty
clearing stations of other armies.

In addition to these eleven casualty clearing stations, the
Second Army had two casualty clearing stations in back areas,
No. 50 at Mont des Cats, and No. 15 at Hazebrouck, to which
sick and wounded could be transferred if necessary.

A labour company was allotted to act as stretcher bearers
at the casualty clearing stations, thirty men being distributed
to each, and thirty to each of the ambulance train sidings. The
work of loading and unloading patients at the casualty
clearing stations was mainly carried out by them.

The general distribution of wounded to casualty clearing
stations was for the main dressing stations of the northern
sectors of the Xth Corps to be cleared to Mendinghem, those
of its southern sector and the northern sector of the IXth Corps
to Remy siding, those in the southern sector of the IXth Corps
and northern sector of the Ilnd Anzac Corps to the casualty
clearing stations at Bailleul, and those in the southern sector of
the Ilnd Anzac Corps to the Australian casualty clearing station
at Trois Arbres. Two casualty clearing stations, No. 11 and
No. 3 (Canadian) were intended to receive walking wounded only.

Casualty clearing stations, with the exception of those
set apart for the reception of the lightly wounded, received
patients in rotation, 150 at a time. This enabled surgical
operations to be carried out with the least possible delay,
and in fact during the first three days of the battle as
many as 2,400 major operations were performed.

The total number of wounded was considerably less than was
anticipated, and at no time was there any difficulty in dealing
with them in the medical units. There were many more in
the area of the Ilnd Anzac Corps than in the corps farther north.
They began to arrive very early at Trois Arbres and Bailleul
casualty clearing stations, in fact, in little over an hour after the
attack commenced. The evacuation of wounded from the
regimental aid posts to the corps main dressing stations was thus
extremely rapid. The chief difficulty was felt at Bailleul where
the casualty clearing stations were in buildings with narrow
approaches and situated some distance from each other.
Owing to the simultaneous arrival of cars bringing wounded and
cars for evacuating wounded to the ambulance trains in the
narrow approaches to the casualty clearing stations in the town
it became necessary to increase the numbers received in rotation
in the casualty clearing stations at Bailleul to 250 lying down

THE BATTLE OF MESSINES 123

cases, so as to give time for evacuation to take place before
convoys began to arrive with fresh cases. This difficulty at
Bailleul was consequently only very temporary.* The rapid
evacuation of wounded to the casualty clearing stations was
in a measure due to the arrangements which had been made
before the battle to distribute sterilized dressings in suitable
sizes to the field ambulances for use at the regimental aid posts
and dressing stations, thus reducing considerably the time
taken to prepare wounded for further transport.

The Ambulance Trains. — During the first three days of the
battle thirty-five ambulance trains or temporary ambulance
trains were used. Sixteen trains had been garaged in the army
area before midnight of the 6th/7th June, and each train as it
moved up to the casualty clearing stations was replaced by
another from the garage. On the first day ten ambulance trains
and two temporary ambulance trains ran from the casualty
clearing stations to the base ; on the second day twelve
ambulance trains and three temporary ambulance trains, and
on the third day eight ambulance trains and no temporary
ambulance trains.

The Medical Services with Divisions and Corps.

The arrangements for the work of the medical services in the
divisions and corps engaged in the battle were of a very complete
and methodical character in all.

Ilnd Anzac Corps. — The advance of the Ilnd Australian and
N.Z. Corps was against Messines in the southern sector on the
right of the battle.

The divisions engaged were the 3rd Australian (A.D.M.S.,
Colonel A. T.White), the New Zealand (A.D.M.S., Colonel D. J.
McGavin), and the 25th (A.D.M.S., Colonel H. I. Pocock). The
4th Australian Division (A.D.M.S., Colonel G. W. Barber) was
in support. It passed through the New Zealand Division and
25th Division in the afternoon of the 7th June and carried on
the attack with the 3rd Australian Division.

The medical arrangements were dominated by the physical
features of the corps area. A hill, known as Hill 63 just north
of Ploegsteert Wood, stood out between the right and left
sectors of the attack. The D.D.M.S., Colonel C. W. Begg,
N.Z.M.C, consequently organized two lines of evacuation, one
to the south and one to the north of the hill.

* A similar difficulty had occurred in the Ypres battles of 1915, when
special arrangements had also been made to deal with the rapid arrival of
wounded at Bailleul.

124 MEDICAL HISTORY OF THE WAR

A corps main dressing station and a corps walking wounded
collecting station for the southern area were established at
Pont d'Achelles, where a road from Ploegsteert joins the main
road between Armentieres and Bailleul. This served for the
reception of wounded coming down from advanced dressing
stations and collecting posts on the south and north-east of
Ploegsteert Wood. The advanced dressing stations were at the
Brewery south of Ploegsteert, and at points known as Charing
Cross and Underhill Farm, with collecting posts for walking
wounded at Touquet Berthe and Hyde Park, the latter between
the Brewery and Charing Cross, and the former east of Underhill
Farm. A narrow gauge railway had been constructed in a circuit
running near these posts and leading through Romarin to a
railhead, called the Duke of Connaught railhead, about 1,000
yards north of Pont d'Achelles. The walking wounded were
brought down to the railhead on trollies and from there went
on foot to the dressing station.

From Pont d'Achelles the wounded on stretchers were
evacuated by motor ambulance convoy to No. 2 Australian
CCS. at Trois Arbres, about one mile south-west of Pont
d'Achelles. The slighter cases of wounds and sickness went to
divisional rest stations, formed by field ambulances at Steen-
werck and L'Estrade, about one mile south-east of Steenwerck,
or to No. 11 CCS. at the ambulance train siding south of
Bailleul.

North of Hill 63 in the sectors from which the New Zealand
and 25th Division made the attack, sites for a corps main
dressing station and walking wounded collecting station were
prepared near Westhof Farm, one mile south-west of Neuve
Eglise. They received the wounded from advanced dressing
stations at Kandahar Farm on the Neuve Eglise-Wulverghem
road and at Lindenhoek road one mile north of Neuve Eglise ;
and from collecting posts, Leinster House and Leeuwerck
Farm, south-east and east of Neuve Eglise. This area was hilly
and consequently narrow and broad gauge railways did not run
into it to the same extent as in the southern area, but tram lines
were run from the trenches to the advanced dressing stations.

Wounded were taken by convoys to the casualty clearing
stations in Bailleul.

Divisional rest stations for the New Zealand and 25th Division
were at Ravelsberg, about two miles east of Bailleul on the
Neuve Eglise road and in Bailleul.

Personnel for the corps main dressing stations and corps
collecting stations consisted of a tent subdivision from each of

THE BATTLE OF MESSINES 125

the field ambulances of the divisions engaged. Each of the field
ambulances of the two Australian divisions provided the sub-
divisions for the Pont d'Achelles dressing and collecting
stations. They were placed under the command of Lieut. -
Colonel F. A. Maguire of No. 9 Australian Field Ambulance.
At Westhof the field ambulances of the New Zealand and 25th
Divisions supplied the six tent sub-divisions, under the com-
mand of Lieut. -Colonel H. B. Kelly of No. 77 Field Ambulance.
By this arrangement the divisions retained all their field
ambulances as mobile units. A tent sub-division of No. 4
New Zealand Field Ambulance was also detailed to detrain
patients at the Duke of Connaught railhead and conduct them to
Pont d'Achelles ; and a medical officer of the Australian Army
Medical Corps was detailed to act as medical railway transport
officer and supervise generally the entraining and detraining of
wounded at the various points on the narrow gauge line.

Colonel McGavin of the New Zealand Division was placed in
charge of the general arrangements for clearing wounded to the
main dressing station.

The following clear and precise orders were issued by the
corps. They are a good example of orders for the medical
arrangements during a battle. These orders were adhered to
with very minor alterations.

" Ilnd Anzac Corps Medical Arrangements.
Battle of Messines.

In the proposed scheme, the principle of working with one corps main
dressing station has had to be modified by the fact that the area is
divided by Hill 63 into two approximately equal parts. In order to
fall in with the general scheme of traffic control, it is necessary to
establish two corps main dressing stations. One of these will deal with
cases from the north, the other from the south of Hill 63.

Similarly, the line of evacuation from the north area will be to casualty
clearing stations in Bailleul, while from the south cases will go to Trois
Arbres.

Medical personnel available : —
12 Field Ambulances.

1 Motor Ambulance Convoy.
All available P.B. men.

CCS. — The scheme is based on casualty clearing stations at Trois
Arbres and at Bailleul, with special accommodation for walking cases
at both places. Certain casualty clearing stations will be set apart for
special cases.

Stretcher Cases. — Responsibility for the conveyance of wounded to the
regimental aid posts rests with battalions and brigades. The arrange-
ments necessary for reinforcing the small stretcher bearer establishment
should be made before the action. Medical personnel from field ambu-
lances should on no account be used for this purpose.

A.D.S. — Field ambulances take over cases at the regimental aid posts
and convey them by hand carriage, wheeled stretchers, etc., to advanced
dressing stations. Trench tramways should be made use of, and special

126

MEDICAL HISTORY OF THE WAR

" gates " for carrying five stretchers on a truck should be ready. Arrange-
ments must be made with the tramway operating staff to assist in every
possible way.

C.M.D.S. — From the advanced dressing stations cases are conveyed
by divisional motor and horse ambulances to the corps main dressing
stations, where divisional responsibility ceases.

Walking Cases. — Special provision must be made for walking cases.
They must on no account be allowed to enter the advanced dressing
stations. Divisional collecting stations should be formed at convenient
places not in the vicinity of an advanced dressing station. There walking
cases should be fed, dressed if necessary, and sent on by returning
empty transport, 60 cm. railway and lorries, if available. The
routes for walking cases should be well marked by notices, and by lights
at night, showing the way to the corps collecting station.

Records. — All records will be kept at the corps main dressing stations
and at the corps collecting stations. Serum. — Anti-tetanic serum will
also only be administered at these stations.

Evacuation of sick and wounded. —

For this purpose the corps sector is divided into two sub-sectors —

1. South of Hill 63 — from the River Lys to the Douve.

2. North of Hill 63 — from the Douve to the North of sector.
Sub-sector 1.

Corps main dressing station
Advanced dressing stations

Regimental aid posts

Pont d'Achelles B.8.b.3.5. *
Brewery C.l.d.4.5.

Charing Cross U.19.d.l.5.
Underhill Farm T.18.C.5.3.
C.9.d.4.2.
C.3.C.8.3.
U.21.a.2.8.
U.14.d.8.7.
U.14.d.3.7.
U.14.a.6.8.
Corps main dressing station will accommodate 600 stretcher cases.
Corps collecting station will accommodate 700 walking cases.
The personnel required for these stations will be six complete tent
sub-divisions, which will be supplied by the divisions evacuating to these
stations.

Sick. — The divisional rest station at L'Estrade will be used as a corps
hospital for the sick of two divisions. One tent sub-division will be
sufficient for this work.

Trivial wounds. Shell-shock. — The divisional rest station at Steen-
werck will be used as a corps hospital for very slight wounds and " shell-
shock " cases.

Walking cases. — Divisional collecting posts for these will be established
at Touquet Berthe, U. 26. a. 2.1, and in the vicinity of Catacombs. These
posts will be evacuated to the corps collecting station at Pont d'Achelles.
B.8.b.3.5.

Sub-sector 2.

Corps main dressing station .
Advanced dressing stations .

Regimental aid posts . .

T.19.b.4.5.

Kandahar Farm T.10.b.7.7.
Lindenhoek Road T.3.a.0.4.
Spring Street U.7.b.3.5.

Fort Osborne U. I.e. 3. 4.

Boyle's Farm U.l.a.4.0.

Pont de St. Quentin T.6.C.1
Shamus N.35.d.6.0.

* These map references are as they appear in the orders. They indicate
the exact position in the squared maps of the 1 in 40,000 scale.

THE BATTLE OF MESSINES 127

Walking Cases. — Divisional collecting posts for these will be established
at Leeuwerck Farm, T.10.d.4.2 and White House, T.10 central. These
posts will be evacuated to the corps collecting station at T.19.b.4.5.

Corps main dressing station will accommodate 600 stretcher cases.

Corps collecting station will accommodate 700 walking cases.

The personnel required for these corps stations will be six complete
tent sub-divisions, which will be supplied by the divisions evacuating to
these stations.

Sick — The divisional rest station at S.16.C.3.2. will be used as a corps
hospital for the sick of two divisions. One tent sub-division will be
sufficient for the work.

Trivial wounds. Shell-shock. — The divisional rest station at Bailleul
will be used as a corps hospital for very slight wounds and " shell-shock "
cases. This and the similar station for the southern area, will each
require one complete tent sub-division.

Reserve of ambulances. — A pool of ambulance cars from the division in
reserve will be formed, and these will be available, on application from
an A.D.M.S. to the D.D.M.S., to assist at any point where the casualties
have been particularly heavy.

M.A.C. — The O.C., M.A.C., will be responsible for the evacuation of
cases from the corps main dressing stations and the corps collecting
stations to the casualty clearing stations at Trois Arbres and Bailleul,
and to the various corps hospitals. In the case of slightly wounded men
(walking cases), he will arrange to make full use of returning motor
lorries and other transport. He will set apart a few cars for the con-
veyance of special cases (such as head and abdominal) to special operating
centres.

Spare stretchers and blankets. — At each main dressing and collecting
station a N.C.O. will be detailed to see that every ambulance, on unloading,
is supplied with its full complement of stretchers and blankets. In
addition to the usual supply of 150 stretchers and 400 blankets per
ambulance a large number will be kept at the main dressing and collecting
stations. It will be the duty of the O.C., M.A.C, to ensure that this
supply is maintained.

The primary principles for successful evacuation are : —

Stretcher cases : —

1. Regimental aid posts prepared far forward, but not occupied till

the troops are about to advance, to save stretcher bearers.

2. Route of evacuation to advanced dressing stations, which should

be at the most advanced point to which ambulances can be
brought, at right angles backward from the line of advance,
to save field ambulance bearers.

3. Route of evacuation from advanced dressing stations to be the

shortest possible road to main dressing stations to save divisional
ambulance transport.

4. The formation of corps main dressing stations and corps collecting

stations to save motor ambulance convoy cars.

Walking cases : —

1. Clearly marked routes to divisional collecting posts. These posts

should not be near advanced dressing stations.

2. Collecting posts, where walking cases can be fed, dressed if

necessary, and loaded on returning transport.

Note. — Returning empty railway stock will be available for the
conveyance of wounded subject to the proviso that the stock is not
deflected from its route.

A halt of five minutes can be arranged for the clearance of the
wounded."

128 MEDICAL HISTORY OF THE WAR

The A. D. M.S. of the 25th Division, whose line of advance was
on the north of the Neuve Eglise-Messines road, had organized
a scheme of collecting wounded by battalions, which departed
from the normal system. In consequence of the narrowness
of the front the battalions were to advance by " leap-frogging,"
that is, after one battalion had gone a certain distance, another
fresh one was to pass through it and go on. Regimental medical
officers at a conference with the A.D.M.S. agreed that the
stretcher bearers of the battalion in front should carry back
wounded to the headquarters of the battalion next behind and
then return to their own aid post. The bearers of the battalion
leap-frogging to the next position were then to carry back to
the original British front line trench and so on in succession.

This arrangement meant a series of relay posts, worked by
battalion, instead of by field ambulance stretcher bearers. It
was said on the whole to work satisfactorily but it had some
important defects. The bearers who went forward with their
companies were not always available for relay work. Large
numbers of wounded of different units came through some and
not through others of the aid posts, so that the bearers and
stretchers of the battalion carrying on the relays were in some
cases too few to cope with the work. When the 4th Australian
Division passed through in the afternoon of the 7th June, many
of their wounded had also to be brought back by the battalion
bearers of the 25th Division. It happened too, in one or two
cases, that the battalion bearers carried wounded back to the
advanced dressing station and were consequently a long time
away from their battalions, so that when the relay in front
arrived at the aid posts with wounded no bearers were for the
time being at the aid post to carry them on to the next relay.
German prisoners, however, were employed on their way to the
rear to carry wounded on improvised stretchers made of duck
boards and other material, and were thus of great assistance.
Normally it is the bearer division of field ambulances that
would establish a system of relays for bringing back wounded
to an advanced dressing station from regimental aid posts,
and on the whole the method adopted by the A.D.M.S. of the
25th Division, even in the circumstances of this attack, did not
work as well as the normal method probably would have done.

The IXth Corps.— The IXth Corps, (D.D.M.S., Colonel J. B.
Wilson), held the centre of the attack with the 16th, 19th and
36th Divisions and with the 11th Division in reserve. On the
9th June the 16th and 36th Divisions on the right and left of the
attack were withdrawn from the line, and it was then held by

THE BATTLE OF MESSINES 129

the 11th Division on the right and the 19th Division on the left,
the front having then been contracted to 2,225 yards. The
depth of the advance had been 4,500 yards.

The headquarters of the corps were at Mont Noir. Main
dressing stations and walking wounded collecting stations were
prepared for each of the three divisions, in this way differing
from the other corps, which prepared corps main dressing
stations. For the right division the main dressing station was
at Dranoutre, with a walking wounded collecting station at
Donegal Farm, about one mile farther east on the southern
slopes of Mont Kemmel. The centre division had its main
dressing station in a hospice at Locre, with its walking wounded
collecting station in a field near the junction of the Kemmel-
Westoutre and Kemmel-Locre fork roads, about 1,000 yards
east of the main dressing station. The left division had its
main dressing station at Westoutre, and its walking wounded
collecting station at La Clytte. There was a corps rest station
for the sick of the corps at a small farm, Keerseboom, about
two miles north-east of Bailleul.

The main dressing stations were organized with accommoda-
tion for 425 at Dranoutre, 700 at Locre, and 420 at Westoutre,
and the walking wounded collecting stations connected with
them for 300, 400 and 400 respectively. The corps rest station
had accommodation for 600 sick or lightly wounded, 200 beds
being allotted for each of the 36th, 16th and 11th Divisions,
while the 19th Division established a separate rest station for
150 beds at Westoutre.

The advanced dressing stations feeding these main dressing
stations were at Lindenhoek for the right sector, at Kemmel
Brewery for the middle sector, and at the Laiterie on the
Kemmel-Vierstraat road for the left sector, with another
farther north at Kleine Vierstraat.

The regimental aid posts were all situated in communication
trenches and at or near trench tramways. These tramways
were to be used as much as possible for evacuating to the
advanced dressing stations, on the positions of which they
converged.

The positions of collecting posts for walking wounded were
selected so that the walking wounded could be directed away
from the advanced dressing stations and thus avoid congestion
at the latter. The general arrangements were made with the
object of keeping the line of evacuation for serious cases, as far
as possible, apart from the line of evacuation for the light cases.
Consequently the walking wounded collecting stations were so

130 MEDICAL HISTORY OF THE WAR

situated that they could be reached by cross-country tracks
from the front. The tracks were marked with red cross guiding
flags and box lanterns. From the collecting posts walking
wounded were transferred by horse transport, buses and lorries,
and full advantage was taken of returning supply and ammuni-
tion trains on the broad gauge and light railways, whenever
they were available.

The divisional trench tramway officers took up their position
in or near the advanced dressing stations, and were responsible
that the trollies, which were fitted with gates for carrying
stretchers and were drawn by mules, were supplied to the
regimental aid posts as fast as the number of casualties re-
quired, and that breaches in the line, which were of frequent
occurrence from artillery fire, were repaired as rapidly as
possible.

Two officers and twenty other ranks were placed on duty at
the Duke of York's siding on the railway line just east of
Bailleul to receive the walking wounded cases from trains
coming back from the front, and conduct them to No. 11
CCS. A similar party was posted at Wippenhoek Siding
south of Remy Siding to receive and detrain any wounded
arriving from La Clytte by railway, and conduct them either
on foot or by ambulance transport to the casualty clearing
stations at Remy Siding.

A convalescent camp for about 1 ,000 patients likely to be fit
for duty within four or five days was established at Berthen,
about halfway between Bailleul and Poperinghe.

All these posts were formed by field ambulances or sections
of field ambulances of the divisions.

In order to assist the regimental stretcher bearers in collecting
wounded, divisional commanders were instructed to provide,
if possible, 100 extra bearers from each brigade. They were to
be held in readiness at advanced brigade headquarters and
supplied with stretchers sent up to the regimental aid posts.
The field ambulance stretcher bearers were responsible for
evacuating the wounded from the regimental aid posts, mainly
by means of the trench tramways. The R.A.M.C bearers had
been trained for some months beforehand in the use of trollies
with gate ends fitted on them so that each trolley could com-
fortably carry four lying down cases and their kits. This scheme
worked admirably and wounded were brought back quickly and
in good condition. German prisoners were also utilized as
bearers and were of the greatest assistance. The system of
bearer relay posts and the situation of regimental aid posts are

THE BATTLE OF MESSINES

131

well illustrated in the following sketch map of the 36th Division
medical situation during the battle.

-L/ccne-THE &ATTLE OF MESSINES. -/9/7-
Map of Medical. Situation Front Area 36 r - M Division.
Smowinq system of Relay Posts.

■+* Rsa.'AoPtarr.
— <*- Line oramcuA.'noM.

IOOO

900 O

1 ■ . I > |

The advanced dressing stations were large shell-proof dugouts
j or cellars at points where motor cars could be brought up.

The main dressing stations were in large Nissen hospital huts,
marquees or buildings.

The motor ambulance convoy was worked on the continuous
chain principle, that is to say, a car was sent to each main
dressing station every six minutes during the acute phase of the
: attack. This system worked very successfully, and the convoy
kept well in advance of the situation, evacuating 2,200 cases to
the casualty clearing stations between 3 a.m. on the 7th June
and noon on the 10th June.

Between La Clytte and Wippenhoek three special trains
were employed for conveying the walking wounded from the
former post, and in addition a lorry service was organized, a
lorry being sent to each of the three walking wounded collecting
posts two hours after the attack was launched and every half
hour afterwards so long as the fighting continued. These lorries
were fitted with bench seats and palliasse cushions, and had
ladders with a hand rail for assisting the wounded to get into
them.

Colonel Bo wen, the A.D.M.S. of the 16th Division, was
seriously wounded in the chest by a shell fragment on the 8th

10134

132 MEDICAL HISTORY OF THE WAR

June while visiting the regimental aid posts, but fortunately
recovered and returned to France in February 1918.

The Xth Corps. — The Xth Corps held the sector on the left
flank of the attack south-west and north-east of the Yser Canal
from the Diependaal Beek to Observatory Ridge. It had the
Ilnd Corps on its left in the short sector between the Ypres-
Menin road and Observatory Ridge. Its divisions were the
41st, 47th and 23rd, with the 14th in reserve. The D.D.M.S.,
Colonel R. L. R. Macleod, had his headquarters somewhat far
back at Abeele on the Belgian frontier.

The front area, including the Ilnd Corps sector, before it was
handed over to the Fifth Army, consisted of four sectors ;
from right to left, the St. Eloi sector, the Bluff sector, Obser-
vatory Ridge sector, and the Hooge sector. A series of collecting
posts was prepared behind each of these sectors at Voorme-
zeele, Spoilbank, the Bluff, Cow Farm and Menin Mill, with a
series of advanced dressing stations farther back at Dickebusch,
Woodcote Farm, the railway embankment, the Zillebeke Bund,
and the asylum at Ypres. Farther back there was one large
corps collecting post on the Ypres-Dickebusch road, south-west
of Kruisstraat, to which both lying down cases and walking
cases were brought, and from there sent to a main dressing
station with accommodation for 600 seriously wounded, and
another for 1,000 lightly wounded at Brandhoek, the former
being in a school south of the railway, and the latter in tents
on the north side. There was also a main dressing station for
800 lightly wounded on La Clytte road half-way between La
Clytte and Reninghelst. There was a divisional rest station for
each division with accommodation for 400.

A special feature in the arrangements of the Xth Corps was
the preparation of a collecting post at Vlamertinghe Mill for the
reception of casualties from gas poisoning. The month of June
was considered by the gas experts as a specially favourable
month for attacks by lung irritant gases, and this fact had been
brought to the notice of the corps and divisional D.Ds.M.S. and
A.Ds.M.S., but the Xth Corps appears to be the only corps
which made separate arrangements for collecting and evacuating
the gas casualties.

The lightly wounded from other sectors than the St. Eloi
sector, which cleared to La Clytte, were brought to Brandhoek,
either through the corps collecting post or by way of a post at
the Lille Gate of Ypres, or through Ypres and by way of the
advanced dressing station at the asylum. The seriously wounded
went to the main dressing station at Brandhoek, either direct
or through the corps collecting posts.

Diagram showingXCorps scheme of evacuation

FOR CASUALTIES IN PREPARATION FDR

THE Battle of Messinesv June 1917.

Lying down & car cases.

*■ Walking & lorry casks.

K'oN^ v Gas and car cases.

HoTE t A/t/Mae*s USBS3SSS.

^ +TION AT £ACH POST

t3.284BC 5060/I4-I. t5QO.ll.23

H.M.S.O.Ci

THE BATTLE OF MESSINES 133

The general scheme is shown on the diagram, which was
prepared by the D.D.M.S. of the Corps in May ; but as the
Ilnd Corps took over the Hooge sector before the attack
of the 7th June, these arrangements were modified to some
extent.

The walking wounded cases were evacuated at first to the
casualty clearing stations at Remy Siding, but this was altered,
and the lightly wounded from Brandhoek were subsequently
cleared to the casualty clearing stations at Mendinghem.
Some of the lightly wounded, however, from the dressing
station on the La Clytte road went direct to the divisional rest
stations.

The lightly wounded were brought back from the advanced
dressing stations by horsed ambulance wagons, empty supply
lorries or general service wagons to the dressing station at
Brandhoek, and the seriously wounded by a motor ambulance
convoy improvised by the D.D.M.S. out of the ambulance
cars of the divisional field ambulances. It assembled on the
road between Kruisstraat and Vlamertinghe. From the
collecting posts and advanced dressing stations wounded were
taken to the corps collecting station or to the advanced dressing
station at Dickebusch by hand carriage or trench tramways.
Motor lorries were employed for conveying lightly wounded
from Brandhoek to the casualty clearing stations. Arrange-
ments were also made for ambulance trains or temporary
ambulance trains being run as far as Brandhoek to clear both
the dressing stations there to the lines of communication or
bases direct, if necessary. This is well illustrated in the
diagram of the scheme of evacuation in the 23rd Division.

But practically all the regimental aid posts, collecting posts,
and advanced dressing stations were situated at or near trench
tramways, and, as far as possible, the wounded were brought
back on these by field ambulance bearers. The chief difficulty
experienced in this method of evacuation was the frequent
damage to the lines by artillery fire.

In addition to the trench tramways, a light railway ran
from the front areas to a point known as Wellington Junction,
situated about one and a half miles south of Brandhoek. From
there a light railway ran to join the main line west of Brandhoek
Siding. Wounded, who might arrive by the light railway at
Wellington Junction, were received there by a field ambulance
detachment and sent to Brandhoek by a shuttle service of
trains. There was another light railway running from Zeve-
coten, near Reninghelst, to Wippenhoek, where a divisional

(10134) L*

134 MEDICAL HISTORY OF THE WAR

rest station of the 41st Division was established. It was used,
when necessary, to bring lightly wounded from the walking
wounded collecting station on the La Clytte-Reninghelst road
by empty supply trucks direct to the rest station.

Evacuation of the Wounded.

Owing to the rapidity with which the wounded were coming
into Bailleul, the casualty clearing stations there in the early
morning of the 8th June became somewhat congested. This
was specially felt at No. 53 CCS. in the asylum in the northern
outskirts of Bailleul. Patients were then diverted from the
southern sector of the IXth Corps to Remy Siding in order
to relieve this congestion, No. 53 CCS. being closed for the
reception of wounded for six hours. Lying-down patients were
also diverted then to No. 11 CCS. in rotation with the other
casualty clearing stations in Bailleul in place of No. 53. The
congestion in Bailleul was further relieved by transferring
patients by road to Hazebrouck, and by sending up a convoy
of fifty cars from St. Omer, to transfer 400 patients to the
hospitals in the St. Omer area.

Much congestion was also experienced at Remy Siding in
No. 3 Canadian CCS. by the number of lightly wounded
patients arriving there. The arrangement by which casualty
clearing stations were allotted for walking wounded only, did
not, in fact, prove satisfactory. The orders on the subject were
consequently cancelled during the battle, and all the casualty
clearing stations at Remy Siding then received lying down
cases in rotation, as in the case of No. 11 CCS. and those in
Bailleul.

The New Zealand Stationary Hospital had been transferred
to Hazebrouck from Amiens on the 25th May as a special
hospital for gunshot wounds of the head. The distinguished
American surgeon, Major Harvey Cushing, who belonged to the
staff of No. 11 (Harvard) General Hospital, was attached to
it as operating surgeon during the battle. Owing to the large
number of head cases requiring operation, which had accu-
mulated at the New Zealand Stationary Hospital, fifty of them
were transferred to No. 7 General Hospital, St. Omer, by road.

TWO LEFT BATTALIONS

L " T3.

TWO CENTRE BATTALIONS TWO RIGHT BATTALIONS

ADV. DRESSING STATION
ZILLEBEKE BUND

DIV. COLLECTING ST*
FOR WALKING WDP
LILLE GATE YPRES
LORRY LOADING POINT

FIELD AMB.H.Q.

DRESSING STN.
AND BEARERS CAMP
VIAMERT1NGHE MILL

DIV. REST STATION
AND GAS TENTS
WAR AT AH CAMP

r^*y\ CORPS MAIM DRESSING
/Vr-f-k. STATION FOR SEVERELY
*~??l WOU

/ /

CASUALTY CLEARING ST"
REMY SIDING

S&fiftj r J ~l j •• • »» Fj-fi'i iTiT) (T7. 777} fTTTTTTT [7777771

WALKING WOUNDED
STRETCHER CASES
GASSED.

ALTERNATIVE ROUTES
ALTERNATIVE ROUTES

Scheme of Evacuation of Wounded from the 23 r - Division
during the Battle of Messines.

Malby&SonsXith.

THE BATTLE OF MESSINES

The Casualties.

135

The number of wounded admitted to the medical units of
the three Corps during the first three days of the battle was as
follows : —

Ilnd Anzac
Corps.

IXth
Corps.

Xth
Corps.

Total.

7th June

8th June
9th June

4,414
3,103

1,350

2,368
898
339

1,963
2,097
1,027

8,745
6,098
2,716

Totals

8,867

3,605

5,087

17,559

The wounds were on the whole very severe, and were mainly
caused by high explosive shells and shrapnel. Only about 5
per cent, were attributed to rifle or machine gun bullets.

The number of gassed patients during the battle was con-
siderable. Most were in the Ilnd Anzac Corps area and went
to No. 2 Australian CCS. Some battalions which advanced,
before the creeping barrage had lifted, sustained casualties
from the fire of the British guns.

The casualties amongst the personnel of the medical services
were : —

Officers Killed .. 4

Wounded . . 6

Other ranks Killed .. 24

Wounded .. 130

Some records were kept in one or more divisions of all three
corps to show the proportion of stretcher cases to walking
cases collected by their field ambulances. The results are
shown in the following table : —

Division. Period.

Total collected.

Percentage of total.

Walk-
ing.

Sit-
ting.

Lying.

Walk-
ing.

Sit-
ting.

Lying.

N.Z. 3 a.m. 7th June")

to \

9 a.m. 9th June J

25th 3 a.m. 7th June*)
to y
Noon 9th June J
19th 7th and 8th June
41st &\
23rd /

980

2,879

1,037
2,912

1,620

1,232

61-9

69-3
69-8

1,767

459

1,262

38- 1

30-7
30-2

136 MEDICAL HISTORY OF THE WAR

An average of all these figures shows the percentage of walking
cases to be 64-2 and of the lying cases 35-8 of the total, or
approximately two walking cases to one stretcher case.

The records, however, are not altogether satisfactory as a
means of comparison, for the extent to which sitting cases
were regarded as stretcher cases or as walking cases is not
clear.

The Weather.

The weather was hot and on some days sultry, with heavy
thunder showers on the evening of the 7th and 12th June,
otherwise it was fine and generally the best possible weather
for the work of collecting the wounded, whose comfort and
treatment were thus in no way affected by unfavourable
weather conditions.

CHAPTER VIII.

THE BATTLES OF YPRES, 1917.

THE battles of Ypres in 1917 resembled in many respects
the battles of the Somme in 1916 ; that is to say, they
constituted a series of attacks, by a succession of divisions, over
an extensive area of shell-devastated country with the object
of driving the enemy from dominating positions on high
ground. The operations were interrupted by heavy and
continuous rains, and it was impossible to take full advantage
of initial successes. The ground over which the troops fought
became in many places " a succession of vast muddy pools.
The valleys of the choked and overflowing streams were speedily
transformed into long stretches of bog, impassable except by
a few well-defined tracks which became marks for the enemy's
artillery."* Successive attacks were consequently delayed
until spells of fine weather, which were by no means frequent
or prolonged, dried the ground sufficiently for the operations
to be continued.

The battles extended over the period 31st July to 10th
November. After the opening battle on the 31st July, rain
fell incessantly and operations were delayed until the 16th
August, when they were again, on the 19th August, interrupted
by weather conditions till the 20th September.

Outline of the Operations.

The attacks were successively directed against the Pilckem
Ridge (31st July to 2nd August), Langemarck (16th to 18th
August), Menin Road Ridge (20th to 25th September), Polygon
Wood (26th September to 3rd October), Broodseinde (4th
October), Poelcappelle (9th October), and Passchendaele in two
attacks on the 12th October and between the 26th October
and 10th November.

In the Battle of Pilckem Ridge the Ilnd (24th, 30th and
8th Divisions), XlXth (15th and 55th Divisions), XVIIIth
(39th and 51st Divisions), and XlVth Corps (38th and Guards
Divisions), all in the Fifth Army, with the 41st Division of the
Xth Corps, Second Army, supporting the right of the attack,

* Sir Douglas Haig's despatches, p. 116.

138 MEDICAL HISTORY OF THE WAR

were engaged from in front of Klein Zillebeke to Boesinghe,
and French divisions extended the attack on the left between
Boesinghe and Steenstraat. An advance of approximately
two miles in depth was made, reaching the enemy positions
from Westhoek to St. Julien and along the line of the Steenbeek
beyond the Pilckem Ridge.

In the Battle of Langemarck, on the 16th to 18th August,
the divisions chiefly engaged were the 56th and 8th in the
Ilnd Corps, the 48th and 11th in the XlXth Corps, and the
29th and 20th in the XlVth Corps. The line was then advanced
to Langemarck, but was little changed in other sectors.

After this wet weather continued. For the subsequent
battles, which were fought in order to capture the Menin Road
Ridge between Gheluvelt and Broodseinde, the Second Army
front was extended northwards and the operations were con-
ducted by it north and south of the Menin Road in conjunction
with attacks by the Fifth Army further north. The 1st Anzac
Corps had been transferred to the Second Army from the
Third Army at the end of July, with the 1st, 2nd and 5th
Australian Divisions, to which the 4th and 3rd Australian
Divisions were added in August and October. The 25th and
47th Divisions were also in the 1st Anzac Corps for a short
time in August. The VHIth Corps, which had been a reserve
corps of the Fifth Army, was restored to the Second Army at
the beginning of September. The Canadian Corps, composed
of the four Canadian Divisions, was transferred from the First
to the Second Army in October ; so that during the battle on
the Menin Road Ridge and subsequent battles the Second
Army had at its disposal three corps in addition to those
(Ilnd Anzac, IXth and Xth Corps) with which it had fought
the battle of Messines.

In the Battle of Menin Road Ridge on the 20th September
the Xth Corps, with the 19th, 39th, 41st and 23rd Divisions,
was engaged south of the Menin Road, and the 1st Anzac
Corps, with the 1st and 2nd Australian Divisions, north of the
road. The Fifth Army, further north, attacked along the
Ypres-Roulers railway at the same time with the 9th and
55th Divisions of the Vth Corps, which had previously been
in reserve, and on their left north of the Zonnebeke-Langemarck
road with the 58th and 51st Divisions of the XVIIIth Corps.
The line was advanced to Polygon Wood and north of Lange-
marck. The fighting was continued on the 26th September,
chiefly by 1st Anzac Corps divisions (5th and 4th Australian)
and Vth Corps divisions (3rd and 59th), with the 39th and 33rd

MalbyiSonsLiUi

THE BATTLES OF YPRES, 1917 139

Divisions of the Xth Corps on their right flank astride the
Menin Road and the 58th Division of the XVIIIth Corps on
the left flank south-east of St. Julien.

The Battle of Polygon Wood was a series of heavy counter-
attacks which were continued into October.

The Battle of Broodseinde was fought on the 4th October, when
the Second and Fifth Armies renewed the attack, directing it
against the main line of the ridge east of Zonnebeke from
the Menin Road to the Ypres-Staden railway over a front of
seven miles. Twelve divisions were engaged. The 37th of the
IXth Corps south of the Menin Road, the 5th, 21st and 7th of
the Xth Corps between it and Polygon Wood, the 1st and
2nd Australian of the 1st Anzac Corps between Polygon Wood
and the Ypres-Roulers railway, the 3rd Australian and New
Zealand of the Ilnd Anzac Corps, which had been brought up
from the right of the Second Army to its left flank, between the
Ypres-Roulers railway and the Ypres-Gravenstafel road, the
48th, 1 1th and 4th of the XVIIIth Corps on the right of the Ilnd
Anzac Corps to Langemarck, and the 29th of the XlVth Corps
astride the Ypres-Staden railway. The result of the battle
was a great advance, and the British line was now established
along the main ridge from the west of Gheluvelt through
Broodseinde to the Ypres-Roulers railway, where it bent
north-west to Poelcappelle and the Ypres-Staden railway, an
advance of some 6,000 yards in greatest depth from the line
held before the attack of the 31st July.

Bad weather again continued, but notwithstanding the
unfavourable conditions and the state of the ground the attack
was renewed on the 9th October, when the Battle of Poelcappelle
was fought in conjunction with the French First Army under
General Anthoine from the east of Zonnebeke to near Merckhem.
The Guards Division and the French on the left of the attack
advanced across a flooded valley, a distance of nearly one and
a half miles, to the Houthulst Forest. The 29th and 4th
Divisions of the same Corps (XlVth) advanced along the
Ypres-Staden railway to east of the Poelcappelle-Houthulst
road; while the 11th and 48th Divisions of the XVIIIth
and the 66th and 49th of the Ilnd Anzac Corps extended the
attack from the east of Poelcappelle to Broodseinde, making
some slight progress.

On the 12th October the First Battle of Passchendaele took
place. The attack was renewed between the Ypres-Roulers
railway and Houthulst Forest by the 1st and Ilnd Anzac
Corps and the XlVth Corps, but the constant rain prevented

140 MEDICAL HISTORY OF THE WAR

the operations being continued. They were renewed again
on the 26th October in the Second Battle of Passchendaele,
when the 3rd and 4th Canadian Divisions of the Canadian
Corps made an attack up the valley of the Ravebeek and
secured high ground south of Passchendaele. The advance
was continued on the 30th October between the Ypres-Roulers
railway and Poelcappelle-Westroosefyeke road by the 3rd and
4th Canadian Divisions and the 58th and 63rd Divisions of
the XVIIIth Corps on their left ; and again by the 1st and
2nd Canadian Divisions on the 6th November, when the village
of Passchendaele was captured. Some further progress north-
wards from Passchendaele was made on the 10th November.

The operations in Flanders then came to an end,* and a
readjustment of army areas again took place, the Fifth Army
being transferred to the area south of the Somme, and the
Second Army headquarters to Italy, its place being taken by
the Fourth Army headquarters, as already noted.

Had the weather conditions permitted of a complete occu-
pation of the Passchendaele ridge and the country beyond
before winter set in, the operations of the Second and Fifth
Armies were intended to be combined with operations of the
Fourth Army on the coast ; but when further progress at
Passchendaele ceased in November there was no longer any
need for maintaining a British front in the Dunkirk-Nieuport
area. The Dunkirk-Nieuport area was consequently re-trans-
ferred to French troops at the close of the operations in Flanders.

The progress made during the various attacks is shown on
the map.

General Medical Preparations for the Battles.

The preparations made for the offensives, more especially
those for which the D.M.S. of the Fifth Army was responsible,
were based upon an anticipation of the complete success of
the operations.

The D.G.M.S. held a conference of Ds.M.S. of armies on the
29th May 1917, when the requirements of the Fifth Army in
its new area were considered. These necessitated the transfer
of various medical units from other armies, in order to build
up a medical strategical position in preparation for the part
the army was to play after the Messines ridge had been captured

* Although the operations described as the Battles of Ypres, 1917, came to
an end on 10th November, raids and minor actions were continued on the Ypres
front, especially in the vicinity of Poelcappelle, by the 1st Division which had
arrived from the Dunkirk area.

THE BATTLES OF YPRES, 1917

141

"by the Second Army. Consequently by the 21st July the Fifth
Army had been well supplied with medical units of all descrip-
tions, apart from the medical units of the divisions of which
it was composed. Its D.M.S., Surg.-General B. M. Skinner,
had then under his control the following units : —

Casualty Clearing Stations —

At Dozinghem . . . . Nos. 4, 47 and 61.

At Brandhoek

Remy Siding

Mendinghem
Bandaghem

Nos. 32, 44 and No. 3 Austra-
lian.

Nos. 10, 17, Nos. 2 and 3
Canadian.

Nos. 12, 46 and 64.

Nos. 62 and 63.

Advanced Depots of Medical Stores —

Dozinghem

Proven . .

Remy Siding
Mobile Laboratories—

Remy Siding

Dozinghem

Mendinghem

Poperinghe
X-ray Units —

Remy Siding

Dozinghem
Motor Ambulance Convoy s-

Proven

Wippenhoek Farm

Remy Siding (near)

Poperinghe (near) at
Chateau, Lovie Road.

Winnezelle, between
Steenvoorde and

Herzeele.

No. 18.
No. 31.
No. 2 Canadian.

No. 1 Bacteriological.
No. 8 Bacteriological.
No. 11 Bacteriological.
No. 23 Hygiene.

No. 5.
No. 7.

No. 4 with the XlVth Corps.
No. 6 with the XlXth Corps.
No. 20 with the Ilnd Corps.
No. 24 with the XVIIIth

Corps.
No. 31 as Army Reserve.

The Fifth Army area had also ten sanitary sections distri-
buted in it *

Surg.-General Skinner had asked for fifteen casualty
clearing stations, and a large number of hospital marquees
and huts for them. Approximately 1,300 marquees and 60
huts were given to him for sick and wounded alone, irrespective

* Four more sanitary sections were asked for from the D.G.M.S. by the
D.M.S. of the Fifth Army to arrive on the 13th August, in consequence of the
new area that had been taken over from the enemy.

142 MEDICAL HISTORY OF THE WAR

of those required for personnel and other purposes. Each
marquee could take 10 wounded and each hut 20, so that 14,200
wounded could be accommodated comfortably at one time ;
while at least 25 per cent, could be added to these numbers
in emergency without inconvenience, bringing the total accom-
modation up to 18,000. By crisis expansion it was estimated
that shelter could be provided in these casualty clearing
stations for 20,000 at one time.

But the D.M.S. of the Fifth Army, not content with this
ample provision, applied for an increase in the number of
marquees on the 13th August, and the responsibility of granting
or refusing these was placed on the D.D.G.M.S. by the Adjutant-
General, who asked him if he was satisfied that the total tentage
already given would meet all the requirements for the number
of wounded likely to arise in any impending operations. The
D.D.G.M.S. considered that they were adequate for reasonable
requirements, with proper distribution and with the existing
means of evacuation. An additional casualty clearing station,
No. 13 from Tincourt, however, was sent to the Fifth Army,
but was kept parked. The intention of the D.M.S. was to
keep it in reserve in anticipation of an extensive advance, and
sites were being prepared for it and others at Elverdinghe.
It went, however, to Arneke eventually at the end of September,
owing to the need of a casualty clearing station in a back area
for the sick of the reinforcements which were being brought
up from the base depots.

On the 21st July the D.G.M.S. issued instructions for the
coming offensive operations. Ds.M.S. of armies not actively
engaged were to retain as many sick and wounded as possible in
the casualty clearing stations and stationary hospitals in their
areas, so as to avoid using ambulance trains and filling the
accommodation in base hospitals. At St. Omer there were
three general hospitals open, No. 7 at Malassises, No. 58 at
the Champs de Mars, and No. 59 in the military hospital,
St. Omer, for surgical cases, and at Moule Chateau, some
five miles distant on the Calais road, for minor cases. There
were also two stationary hospitals, No. 4 and No. 7 (Canadian),
at Arques, and another stationary hospital, No. 4 (Canadian),
was opening at the Chateau at Longnesse, near St. Omer.
These hospitals were to receive sick from the back area of the
Fifth Army, as well as sick and wounded arriving by road or
barge from the Fourth Army in the Dunkirk area, or, in
emergency, from the casualty clearing stations of the Fifth
Army.

THE BATTLES OF YPRES, 1917

143

The distribution of sick and wounded to the casualty clearing
stations and St. Omer was regulated by the following instruc-
tions, issued by the D.M.S. of the Fifth Army on the 24th
July :-

" On and after 9 a.m. on the 26th inst. the following groups of casualty
clearing stations are allotted for the reception of sick and wounded from
the areas detailed in the table.

Attention is directed to the disposal of special cases.
Note. — Forward Area is taken as E. of line Crombeke-Poperinghe-Abeele
Station.
Bach Area is W. of above line, and E. of line Bergues-Noordpeene
Railway.

Casualty clearing
stations.

Area.

Re my Siding—

Nos. 10, 17, 2 and 3 Cana-
dian.

Ilnd Corps. — All sick and wounded.
XlXth Corps. — All wounded and sick from
Forward Area.

Proven (Mendinghem)
Nos. 12, 46 and 64.

Lachrymatory Gas cases from all corps.
Head Injuries from all corps.
XlXtk Corps. — All sick from Back Area.
XVIIIth Corps. — Walking wounded when

carried by vehicles other than motor

ambulance cars. All lying sick from

Forward Area.
XIV th Corps. — Walking wounded when

carried by vehicles other than motor

ambulance cars.

Dozinghem —

Nos. 4, 47 and 61

No. 4.

No. 61.

No. 47.

XI Vth and XVIIIth Corps. — All wounded

using ambulance cars.
XI Vth Corps lying sick from Forward

Area.
Self-inflicted and Infectious. Also Eye

Centre.
Doubtful cases of N.Y.D. Gassed.

Brandhoek. On Zero — ■
No. 32.

On Zero + 2—

Nos. 32, 44 and 3 Austra-
lian.

All abdominal cases from Ilnd, XlXth
and XVIIIth Corps.

All abdominal, severe chest injuries, and
compound fractures of thigh from Ilnd,
XlXth and XVIIIth Corps.

Haringhe (Bandaghem)
No. 63.

No. 62.

XI Vth and XVIIIth Corps.— All sick in
Back Area and sitting sick from Forward
Area.

VI Ilth Corps. — All sick in Back Area.

All N. Y.D.N, cases.

All sick W. of line Bergues-Noordpeene Railway will be sent to
St. Omer or Arques, except self-inflicted wounded, which will be sent
to No. 61 Casualty Clearing Station."

(10134) M

144 MEDICAL HISTORY OF THE WAR

A motor ambulance convoy was allotted to each corps
holding a sector of the front : —

No. 20 to the Ilnd Corps.

No. 6 to the XlXth Corps.

No. 24 to the XVIIIth Corps.

No. 4 to the XlVth Corps.
No. 31 M.A.C. was in army reserve directly under the
D.M.S.

A programme for ambulance trains was drawn up based on
the anticipated occurrence of 20,000 wounded on the first day
of the attack, and of diminished numbers on subsequent days.
There were consequently garaged on the night preceding
the attack 6 ambulance trains and 2 temporary ambulance
trains at Hazebrouck and St. Omer ; 2 ambulance trains at
Dozinghem and 2 at Bandaghem, 1 ambulance train and 1
temporary ambulance train at Mendinghem, and 1 temporary
ambulance train at Remy Siding. It was calculated that
5 ambulance trains and 3 temporary ambulance trains would
come up to Remy Siding during the first twenty-four hours,
4 ambulance trains and 3 temporary ambulance trains to
Mendinghem, and 4 ambulance trains to Dozinghem, capable
of evacuating 12,000. On the second day trains were to run
to evacuate 11,000, on the third day 7,000, and on the fourth
day 5,000 ; each train after loading being immediately replaced
by another from the garage.

The Medical Services of Corps and Divisions in the Opening
Phases of the Battles.
The collection of wounded from the battlefield and their
removal to collecting posts and advanced dressing stations was
controlled by the A.Ds.M.S. of the divisions engaged. Most
of the advanced dressing stations were along or in the
vicinity of the Yser canal banks. The work of the regimental
medical officers and stretcher bearers and of the field ambulance
bearer divisions was immensely handicapped by the mud and
marsh over which they had to collect and bring back the
wounded. Trench tramways and light railways were frequently
broken, and their extension, as the line advanced, was limited
by the state of the ground. It was consequently only in
comparatively short sections that they were able to relieve
the bearers of hand carriage. Horsed ambulance wagons and
motor ambulance cars were also restricted in their use in
advance of the canal bank. Only a few roads were fit for
wheeled traffic, such as the Menin, Zonnebeke and St. Julien

THE BATTLES OF YPRES, 1917

145

roads, and even these for short distances only. Consequently
most of the work of bringing wounded back had to be by
relays of bearers.

The general situation of the divisional and corps medical
posts at the beginning of the operations is shown on the map.

Each corps organized its own medical posts, the D.D.M.S.
of the corps being made responsible for the evacuation of
wounded from the advanced and main dressing stations to
the casualty clearing stations in accordance with the distri-
bution in the instructions quoted above.

Ilnd Corps. — The organization of posts and scheme of
evacuation prepared by the Ilnd Corps D.D.M.S., Colonel
Guise Moores, is shown in the following map.

Battles of Vpres 1917,
Medical Organization M Corps Front Area on July 51 S - T

gsGM-rt-.A/DPosT. ** &Ei^v Post © Coix*cr//va Post

Q Walking Wounded Col.l-£c.t/no o/zD/z^ssjngStat-jo/v.
JJ Advanced Dress/no ^Station. F3 Cogps if a /n £te<e&s//v& Stat/on

r¥&s* B/ZOAD aUAOE KAJLMfAY . ++++>■ Ll ON T &A/L WAY . *— *— t- *— t— 7fiA\MIYAY.

Of 7T7//&S. *~

Note. Ajzjsows /md/cats koaos usso and o/aex^r/OAf f=xxe ei*AGUArr/OAf.

Two corps main dressing stations, one for seriously wounded
and the other for walking wounded, were established near
Dickebusch at a place to which the name of Dunedin was
given. The former was manned by a tent division from a
field ambulance of the 30th Division and by six tent sub-
divisions from field ambulances of the 24th, 25th and 18th

146 MEDICAL HISTORY OF THE WAR

Divisions ; the latter by a tent division from the 8th Division
and two tent sub-divisions from the 24th Division. A centre
for dealing with gassed cases was formed in special marquees
at the dressing station for severely wounded.

In addition to the motor ambulance convoy allotted to the
corps, the D.D.M.S. pooled the ambulance cars of the divisional
field ambulances, with the exception of their Ford cars, and
formed another corps convoy for clearing the advanced dressing
stations to the main dressing stations. Twenty lorries were
attached to it for clearing the walking wounded from the
collecting posts to Dunedin. This convoy was assembled at

The Prison, Ypres, used as a main dressing station.

the Cafe Beige, as shown on the map. The collecting post
on the Menin road was unfortunately damaged by fire during
preparations for the battle and 500 stretchers were destroyed.
The XlXth Corps.— The XlXth Corps D.D.M.S., Colonel
O. R. A. Julian, established two corps main dressing stations
at Brandhoek and at the Red Farm, some 1,000 yards further
back, with a corps walking wounded dressing station at
Vlamertinghe Mill. Regimental aid posts had been specially
constructed, two for the right division on Cambridge road,
between the Ypres-Roulers railway and the Zonnebeke road,
and two for the left division on Oxford road, between the
Zonnebeke and St. Julien roads. The advanced dressing
stations to which the casualties were brought from them were

THE BATTLES OF YPRES, 1917

147

at the Ypres prison, or, as an alternative, at Kruisstraat in
the event of the former being shelled ; and on the canal bank
north of Ypres. There was a light railway from St. Jean to
the Red Farm, and wounded could be sent back by it to the
corps main dressing station at the latter place.

Collecting post close to Lille Gate, Ypres.

It was doubtful whether the collecting post on the Menin
road could be cleared through Ypres, but a new road had been
formed around Ypres to Kruisstiaat, and it was arranged that
if the cars could not pass through Ypres, stretcher cases should
be taken by wheeled stretchers over this road to Kruisstraat
and thence by car to the corps main dressing station.

For use on the light railway running to the Red Farm 50 sets
of stretcher frames had been made and adapted for fitting on
the trucks. Each truck could thus carry 8 lying and 4 sitting

148

MEDICAL HISTORY OF THE WAR

cases, or 16 sitting cases. There were ten of these trucks to each
train, which was calculated to make four journeys in twenty-
four hours. A nursing orderly was appointed to each of the
trains. Less severely wounded could also be sent back on any
of the supply trucks returning empty along this line.

A light railway was also available for walking wounded from
Kruisstraat to Vlamertinghe Mill, and arrangements were made
to send back wounded on the broad-gauge line between
Vlamertinghe and Remy Siding to the casualty clearing stations
at the latter place. For this purpose trains were improvised
by ten large trucks running every two to four hours, each truck

Potijze Road, Ypres Salient.

accommodating thirty sitting cases. These train services were
intended to be supplementary to the bus and lorry service,
so as to avoid any accumulation of wounded at the dressing
stations pending the arrival of the cars.

The motor transport of the field ambulances remained under
the orders of the A.Ds.M.S. of divisions, and was not pooled,
as in some other divisions, to form a corps motor ambulance
convoy. Fifteen charabancs had been placed at the disposal
of the corps by the Fifth Army, and in addition ten lorries were
added from the corps itself. They were used for clearing the
corps walking wounded dressing station to the casualty clearing
stations and to the corps rest station. Supply lorries were

THE BATTLES OF YPRES, 1917

149

running as far as Potijze, and the empty returning lorries could
be used for bringing the less severely wounded to Vlamertinghe
Mill.

The medical situation in the XlXth Corps is shown on the
following map.

Battles of Ypres 1917.
Medical Situation XJK Corps Front Area on July3I s . t

+ Re&mcntai-Aid Post • Coi-lmctwq Post. Q Advanced D*z£s<s'mg <Stat/on

E^^AUKIHOWOUNQED D8.ESS/N0STAT/ON . Q MAIN DtZESS'*«9 STATtON .

<- Buoao CuAQ£ Kajlsvay -»»■>-■ >- Light Rah-way. Affz/eox.Sx.ryzoA/TL/MS.
, . „ J O \ Z 3 4- 5
5cei/<? erf m//es. I + 1 1 1 —l 1

Farm

Siding-.

Oetra/n/ no point
for Walking Myunded :

The XVIIIth Corps.- -The XVIIIth Corps (D.D.M.S.,
Colonel E. G. Browne) had similar arrangements. The regi-
mental aid posts were grouped. The divisions in both sectors
had two grouped aid posts each, as shown on the map, with
two advanced dressing stations — one on the canal bank at
Duhallow, opposite Noordhofwijk, and the other at Essex
Farm, just north of the Brielen-St. Julien road.

A corps main dressing station for seriously wounded was
established at Gwalia Farm, half-way between Poperinghe
and Elverdinghe ; and for walking wounded near Vlamertinghe
on the Vlamertinghe-Elverdinghe road. There were also a
corps collecting station for sick and an officers' rest station at
Poperinghe, a corps scabies centre at Eikhoek, east of the
Poperinghe-Proven road, and a corps rest station in the back
area at Herzeele on the road from Poperinghe to Wormhoudt.

A complete tent division of a field ambulance was allotted
to the advanced dressing station and divisional collecting
post of each division, and the bearer divisions of all three field
ambulances of each division were employed under orders of
the divisional A.D.M.S. for collecting and evacuating the
casualties.

150

MEDICAL HISTORY OF THE WAR

The accommodation at the corps main dressing station for
the seriously wounded was sufficient for 1,000. It was divided
into two sections, each manned by a tent division of a field

Corps main dressing station at Gwalia Farm. Ypres Front 1917.

ambulance from each of the two attacking divisions. It was
intended in this way to deal with the wounded of each division
separately by one of its own field ambulances.

Barn used as reception room in a corps main dressing station
at Gwalia Farm, Ypres Front.

Similarly the corps walking wounded dressing station was
manned by two tent sub-divisions, one from each of the two
assaulting divisions.

THE BATTLES OF YPRES, 1917 151

The corps sick collecting station and the corps scabies
depot were each manned by a tent sub-division from one of
the attacking divisions.

The corps rest station at Herzeele was sufficient to accommo-
date 700 patients, and was capable of expansion to 800. It
was manned by two tent sub-divisions — one from each of the
two divisions in reserve.

The disposition of the field ambulances of the XVIIIth
Corps divisions on the night of the 30th/31st July was conse-
quently as follows, and is instructive as exemplifying the use
of field ambulances as then organized : —

39th Division. — Three bearer divisions under orders of the
A.D.M.S. for bringing wounded to the canal bank. One tent
division manning the divisional collecting post and advanced
dressing station. One tent sub-division at the corps walking
wounded collecting station. One tent division on duty at the
corps main dressing station, and two tent sub-divisions packed
and parked, ready to move if necessary, at the corps main
dressing station.

51 st Division. — Three bearer divisions under orders of the
A.D.M.S. One tent division for the divisional collecting post
and advanced dressing station. One tent sub-division at the
corps walking wounded collecting station. One tent division
at the corps main dressing station, and two tent sub-divisions
at the corps sick collecting station and corps officers' rest
station.

llth Division. — In reserve. One field ambulance parked at
the corps main dressing station. One field ambulance parked
off the Poperinghe-Elverdinghe road about one and a half
miles north-west of Poperinghe. One field ambulance, less a
tent sub-division, parked about the same distance north of
Poperinghe on the Poperinghe-Proven road, and one tent
sub-division at the corps rest station.

48th Division. — Field ambulances parked as in the case of
the llth Division, less one tent sub-division at the corps rest
station.

The whole of the work of collecting and evacuating east of
the canal bank was under the direction of the divisional
A.Ds.M.S., but from the canal bank backwards the corps
D.D.M.S. took over the control of evacuation.

The A.Ds.M.S. of divisions were responsible for flagging their
sectors to show the direction in which the various posts lay.
Each division was allotted 20 wheeled stretcher carriers,
6 horsed ambulance wagons, and 6 Ford ambulance cars.

(10134) n

152

MEDICAL HISTORY OF THE WAR

Tramway lines ran from the positions of the regimental aid
posts to the canal, and were also available for conveying
wounded to the advanced dressing stations. Eight trollies
capable of carrying four stretchers each and 20 carrying one
stretcher each were placed at the disposal of the A.D.M.S. of
the assaulting divisions. Directing boards also indicated the
route to the corps walking wounded dressing station and the
corps main dressing station. It was intended that the walking
wounded should make their own way back from the canal

Battles of Ypres 1917.
Medical Situation Front Area xviii & xiv Corps on July3I s . t

+ fee Ax> Post. *%£lay&>st. & Dysnl. . Coll^ct/ng Post. j& kf*urMG k(*Maer> Cm i Ai^r

Q Advaaicco DfiurssiNQ Station. gj CoeAs Ma*h Q&KS&H& Stat/cw.

+**+ 3*OAD6weE Railway. ■**** Ijsht Rajlway. -*■-*— Tgamway. «■ ~— » Cofu>s &ot//*oA/eY.

Scale i

M/'/es. » » 'i » i i

bank to the walking wounded collecting station by cross-
country tracks and by the roads marked with directing boards,
but lorries returning empty from the canal bank could pick
them up, if necessary.

No. 24 M.A.C., which had been allotted to the corps, was
assembled at the corps main dressing station. It was reinforced
by fifteen motor ambulance cars from each of the four divisions
of the corps, so that the officer commanding the motor ambu-
lance convoy had 110 motor ambulance cars under his control
for evacuating from the advanced dressing stations to the
corps main dressing station and from there to the casualty
clearing stations. Advanced car posts were established
between the corps main dressing station and the advanced

THE BATTLES OF YPRES, 1917 153

dressing stations, from which cars went up to the latter as
cars returned from them. Fifteen charabancs were also
allotted to the corps for clearing the walking wounded from
the corps walking wounded dressing station near Vlamertinghe.

The XlVth Corps.— The XlVth Corps (D.D.M.S., Colonel
Whaite), on the extreme left of the British line and on the right
of the French, had four advanced dressing stations, three for
the 38th Division, on or east of the canal bank, and one for
the Guards Division, at the Old Mill, just north of Elverdinghe.
These were the two attacking divisions in the first phase of
the battle.

The corps main dressing station was established at Canada
Farm, north of the Elverdinghe-Poperinghe road, about
one and a half miles west of Elverdinghe. It was manned
by two field ambulances, one from the 38th and the other
from the Guards Division.

The corps walking wounded dressing station, manned by a
tent division of a field ambulance of the 20th Division, was
established at Mouton Farm, on the same road about half a
mile west of Elverdinghe.

There were divisional walking wounded collecting posts,
one for the 38th Division at Mordacq Farm, half-way between
Elverdinghe and the canal, and the other for the Guards
Division at Bleuet Farm, half-way between Elverdinghe and
Boesinghe. These were cleared by auxiliary buses to Mouton
Farm, and from there by other buses to Mendinghem. Fifteen
auxiliary buses were allotted to the corps for this purpose.

The divisional motor ambulance cars cleared from the
advanced dressing stations to the corps main dressing station,
and the Ford cars were sent as far forward on the tracks east
of the canal as possible to help the work of the stretcher bearers.

The corps main dressing station was cleared by No. 4
M.A.C., but ten ambulance cars were allotted to clear direct
to the casualty clearing stations from the advanced dressing
station of the Guards Division, and ten to clear from the
38th Division advanced dressing stations. These cars were
situated at the corps main dressing station. The remaining
cars were available for evacuating from the corps main dressing
station to the casualty clearing stations at Dozinghem and
Mendinghem.

During the attack the Guards Division advanced dressing
station moved from the Old Mill to Bleuet Farm, and all the
motor ambulance transport of the field ambulances of the
division were brought up to it. In the early morning of the

154 MEDICAL HISTORY OF THE WAR

31st July a motor ambulance car was brought up to Boesinghe
and a loading post established there. This was the first
wheeled transport to enter Boesinghe. In the afternoon a
horsed ambulance wagon was got across the canal, but was
unable to proceed far owing to the condition of the ground.
It had to be left there.

The approximate number of wounded of the Guards Division
that were cleared to the corps walking wounded collecting
post and main dressing station up to noon on the 2nd August
was 52 officers and 1,468 other ranks, exclusive of wounded
of other divisions, corps troops, and prisoners. No great
accumulation of wounded occurred owing to the fact that the
casualties were thus comparatively small. But the A.D.M.S.
of the division, Colonel Fawcus, considered that if there had
been large numbers the accumulation of wounded at the
advanced dressing stations would have been excessive and
that it would have been difficult to deal with them in accordance
with the orders issued by the Corps D.D.M.S., which were
to the effect that all the cases were to be dressed before being
sent back direct to casualty clearing stations.

In commenting upon this order in his diary, Colonel Fawcus
noted that if such a procedure was to hold good on future
occasions more medical officers would have to be provided
and larger accommodation made at the advanced dressing
stations ; and this would have necessitated the advanced
dressing station being established much further back. He
expressed the opinion that for an advance it was best to move
and keep the advanced dressing station as near the line as
possible, moving it as the line advanced ; in fact, to make the
advanced dressing station a loading post only and to clear all
cases from it as rapidly as possible to a place further back,
where the necessary dressings could be carried out in comfort.
This procedure would have been in accordance with the
R.A.M.C. Training Manual and Field Service Regulations ;
an advanced dressing station, as laid down in them, was not
intended to be more than a post at the place where wounded
brought back on stretchers could be loaded on to wheeled
traffic. It is of some interest, therefore, to find a comment
on the effects of a departure from this principle in consequence
of an actual battle experience.

Subsequent Phases of the Battles.

During the subsequent phases of the battles of Ypres in
1917 there was very little change in the general distribution

THE BATTLES OF YPRES, 1917 155

of advanced and main dressing stations in the schemes of
evacuation. The Second Army gradually took over ground
from the Fifth Army, extending its line northwards by the
1st Anzac, Ilnd Anzac, and Canadian Corps. The Vth Corps
had relieved the XlXth Corps from Fifth Army reserve on
the 7th September, and was then on the left of the 1st Anzac
Corps of the Second Army. It took over all the medical positions
of the XlXth Corps. Its 9th and 55th Divisions took part in
the battle of the 20th September. It was relieved on the
27th September by the Ilnd Anzac Corps, and withdrawn to
a back area.

The Casualty Clearing Stations.

The casualty clearing stations at Remy Siding were restored
to the Second Army on the extension of its front, its other
casualty clearing stations being at Godewaersvelde (Nos. 11,
37 and 41), at Oultersteene, near Bailleul (No. 2 and No. 1
Australian), No. 53 CCS. at Bailleul, No. 2 Australian CCS.
at Trois Arbres, and No. 50 at Mont des Cats.

A new casualty clearing station site, named Nine Elms, had
been established near Poperinghe b}/ the D.M.S., Fifth Army,
early in September to take the place of the casualty clearing
station site at Brandhoek. The site at Brandhoek had always
been regarded as too far forward and too much exposed to
the danger of shell-fire, but the Fifth Army Commander
and his D.M.S. were desirous of retaining Brandhoek as a
large casualty clearing station centre, with accommodation for
some 3,000, in anticipation of the line advancing. The fears
regarding this site were justified, for the three casualty clearing
stations at Brandhoek, Nos. 32, 44, and No. 3 Australian,
were shelled out on the 21st August, before the extensive
accommodation provided by them had been of any material
value. It was then decided to evacuate all the wounded by
ambulance trains at once, and the nursing sisters were sent
away. One of the nursing sisters had unfortunately been killed
by a shell, and as shells were falling on the railway platform
it was not possible to send an ambulance train to clear the
wounded. The patients, however, were brought back by
road to Remy Siding, and it is remarkable that five of them,
two suffering from abdominal and three from chest wounds,
who had been operated on during the day and were taken back
to No. 10 CCS. at Remy Siding, apparently suffered in no
way by the journey ; and all — except one, who died six days
later, and one of those wounded in the chest, who happened to

156 MEDICAL HISTORY OF THE WAR

be among the most severely injured and was therefore retained
in No. 10 CCS. — were sufficiently recovered to be transferred
to the base by the end of the month. The two abdominal
cases, it may be noted, had multiple perforations of the intestine.

This experience is of some importance as showing that a
journey of twenty minutes to half-an-hour to a more secure
locality farther back is not likely to be so great a risk to
the patient as his retention in a more forward position which
is in danger of being shelled by the enemy. The delay in
getting a seriously injured abdominal case operated upon at
the earliest possible moment was not, in fact, so much due to
the length of the road journey back by ambulance car, as to
the time taken in bringing him from the place where he fell
to the point where he could be loaded on to the car. Colonel
Soltau, the consulting physician of the Northern Armies, it
may be noted, had also made an emphatic protest to the D.M.S.
against retaining serious chest injuries in the forward position.
The surgeons on duty at Brandhoek had also reported that the
noise of artillery fire in the vicinity had a bad effect on the
wounded, and that the locality was not suitable for retaining
them under treatment, and the determination of the Army
Commander and his D.M.S. to retain casualty clearing stations
there must be regarded as strategically unsound from a
medical point of view.

No. 44 CCS. was the first of the Brandhoek casualty
clearing stations to reopen at Nine Elms. No. 3 Australian,
after being parked during September at Remy Siding, opened
there at the end of the month under the Second Army D.M.S.
No. 32 remained at Brandhoek for a considerable time for the
reception of walking wounded only. Up to the time of the
hostile shelling on the 21st August it had carried out most of
the serious abdominal operations, as No. 44 and No. 3 Australian
did not commence to take in wounded until the 9th and 16th
August respectively.

After Brandhoek had been abandoned the D.M.S. of the
Fifth Army made preparations for bringing No. 32 CCS.
and No. 10 CCS. to Elverdinghe still nearer the front. The
D.G.M.S., however, refused to sanction this, and was supported
by the G.O.C of the XlVth Corps, who considered the locality
too far forward for casualties of his corps, which it served, being
treated there. The distance was 9,500 yards from the front line
and within easy range of enemy mobile artillery in Houthulst
Forest. The site at Elverdinghe, however, was prepared and
huts erected on it in anticipation of an advance, but casualty

THE BATTLES OF YPRES, 1917 157

clearing stations were not opened there at any time during the
battles. A detachment of No. 10 CCS. had been sent to take
over the site from Remy Siding, but was recalled by orders of
the D.G.M.S., and the Army Commander was informed by the
Adjutant-General that No. 10 CCS. was not to be removed
from Remy Siding without instructions from G.H.Q. The
site at Elverdinghe had been heavily shelled on the 29th
August, and was continually exposed to artillery fire and
bombing from the air.

The desire, however, of the Fifth Army to have an advanced
operating centre for abdominal injuries as far forward as
possible was unabated, and positions such as Brielen, the cellars
of the prison at Ypres and shell-proof dugouts were considered,
but the consulting surgeons were not in favour of these being
used.

The officer commanding No. 32 CCS. and a portion of his
staff took up their quarters at Elverdinghe on the 5th November.
The equipment and tent age had been moved there on the 12th
October, when it was found that 40 of the marquees had been
so much torn by fragments of shell that they had to be returned
to store for repair. On the 8th November, however, it was
definitely decided that Elverdinghe could not become a casualty
clearing station centre, and work on the site was stopped.

The Work of Divisions and Corps.

When the Second Army extended its front with the 1st and
Ilnd Anzac and Canadian Corps, the chief features in the work
of collecting and bringing back the wounded were the long
distances and heavy ground over which the bearers had to
carry stretchers. During the fighting of the 20th and 21st
September and 4th and 12th October the carry in the 1st Anzac
Corps was in certain places as much as 8,000 yards, as, for
example, from the front line to the Birr cross-roads on the
Ypres-Menin road. Plank roads had been laid down, but were
so slippery that it was impossible to use even the horsed ambu-
lance wagons on them. The advanced dressing station of the
corps was on the Menin road, opposite the Ecole de Bienfaisance.
From there light railways and tram lines were available.

The Ilnd Anzac Corps had little difficulty in this respect in
its first attack on the 4th October, but in the two subsequent
assaults of the 9th and 12th October the battlefield had been
converted into a sea of mud. Six bearers were required for
each stretcher, and it took five hours on the 9th October to
bring the wounded from a regimental aid post to an advanced

158 MEDICAL HISTORY OF THE WAR

dressing station. It was not possible to run special trains for
them on the light railways, although in some cases trucks
returning empty helped in bringing back sitting cases. Ambu-
lance wagons and cars were frequently held up by traffic
for an hour or more at a time. Notwithstanding these diffi-
culties, most of the wounded were got back by night-time.

The conditions on the 12th October were even worse. The
stretcher bearers had to carry wounded a distance of 6,000
yards, and it took seven hours to get the patients back
to the advanced dressing station. A large number of infantry
was detailed to assist in carrying them, and arrangements
were made to collect them into such shelters as were
available in the front line and supply them with food and
blankets until it was possible to bring them back. In his
observations on these conditions the D.D.M.S. of the corps,
Colonel C. W. Begg, remarks that 600 fresh stretcher bearers
were required on each divisional front every twelve hours, with
a maximum of 300 stretchers and 1,000 blankets. The total
casualties passing through his dressing stations between the 4th
and 18th October were 362 officers and 11,243 other ranks, of
whom 231 officers and 4,412 other ranks were stretcher cases.
The numbers included 12 officers and 424 other ranks gassed.

When the Canadian Corps relieved the Ilnd Anzac Corps
on the 17th October and took over its medical posts, the stretcher
bearers' work was considerably lightened by the laying of
trench mats along the tracks.

In the earlier phases of the battles this system of relay posts
was not so much in evidence, and more use was being made
of trolly lines. Thus the 20th Division (XlVth Corps), in the
battle of the 16th-18th August, depended chiefly on a trolly
line running to Fusilier Farm and the canal bank. The line was
broken several times by shell-fire, but was speedily repaired.
The division was given 200 infantrymen to assist the stretcher
bearers. They were organized into four parties of one officer,
two N.C.O.s and 47 other ranks each, and had been given a
short training in first aid and bearer work for one week. The
parties were used on relay posts, on the trolly lines, with
wheeled stretchers, and as loading parties at entraining and
detraining posts and at advanced dressing stations.

Pack transport was used in some divisions for bringing
material forward to advanced dressing stations and collecting
posts in the later stages of the operations. The 25th Division,
for example, when it was attached to the 1st Anzac Corps in
September, had six pack horses allotted to each field ambulance.

THE BATTLES OF YPRES, 1917 159

The material, consisting of panniers, comforts, reserve dressings,
rations, water, splints, sheets and blankets, directing flags,
and other articles, was brought in limber wagons to Shrapnel
Corner, south of Ypres, and there loaded on to the pack horses.
But notwithstanding the difficulties in bringing the wounded
back to the dressing stations, the general organization led to
so rapid an evacuation that in one or two instances the
casualty clearing stations were overwhelmed and the work of
keeping them clear by means of ambulance trains was much
delayed. This was specially so in the case of the clearing
stations at Remy Siding on the first day of the battles.
M ounded, both walking and lying down wounded, came there
in large numbers, not only by motor ambulance convoy,
charabancs, buses and lorries, but also in ambulance train
coaches and empty trucks of supply trains.

The Organization of Relay Posts.

There were many examples of the organization of relay
work by the stretcher bearers of individual divisions during
the whole period of the battles. The number of relay posts
varied according to circumstances, and the number of bearers
in each according to the orders of individual A.Ds.M.S. As
a rule the divisional or corps commander detailed 200 infantry-
men under their own officers to assist the R.A.M.C. stretcher
bearers ; and the regimental stretcher bearers were doubled.
The relay posts were at distances of 500 to 800 yards from one
another as a rule. In one division the number of stretcher
squads at each post would be four, in another six. There was
no definite rule. The bearers of No. 55 Field Ambulance of
the 18th Division, for example, engaged in clearing regimental
aid posts on the 12th October to Poelcappelle and back to Essex
Farm, had a total carry of 4,500 yards, of which the last 1,500
yards was on a trolly line from Minte Farm. Forty stretcher
squads were used, with an average carry of 800 yards. They
carried back 250 stretcher cases. Derelict tanks were useful
as shelters for relay posts, especially at a point called Delta
House, where there were four derelict tanks.

The 9th Division, fighting on the right of the 55th Division
on the 12th October, formed six relay posts from regimental
aid posts at York Farm and Albatross Farm to cross-roads
on the west of St. Julien, a distance of some 3,000 yards. There
was an entraining point just south of St. Julien, and horsed
ambulance wagons and Ford cars could come up to St. Julien ;
but the larger cars could only work between California Farm

160 MEDICAL HISTORY OF THE WAR

and the advanced dressing station at Duhallow. Thirty-two
bearers were posted at each relay, with 200 infantry men from
the division in reserve.

The Ilnd Anzac Corps formed four relay posts back to an
advanced dressing station at Wieltje for the left division,
and three for the right division to Frezenberg, where horsed
ambulance wagons came up. The D.D.M.S. of the corps
required 600 bearers, 250 from the field ambulances and 350
from other units, as already noted.

When the Canadian Corps took over its front it retained
these two lines of relay posts ; but used a variety of means for
getting the wounded back. In the operations of the 26th
October hand carriage was used to Curve Farm, thence wheeled
stretchers to Spree Farm, followed by another relay of hand
carriage to Midland House, and from there to Wieltje by
petrol tractors on tram lines. There were three or four relay
posts to Frezenberg. From there motor ambulance cars were
able to work on the 26th October. The corps had an advanced
dressing station at Frezenberg, but a shell dropped on it on
the 6th November, causing many casualties, six officers of
the C.A.M.C. being killed and two wounded. Forty-four other
ranks of the C.A.M.C. were also wounded.

The Use of Ambulance and other Trains in the Front Area.

Ambulance train coaches, belonging to No. 38 Ambulance
Train, which had been constructed for use in the Macedonian
theatre of war, were used on a broad-gauge railway between
Ypres and Remy Siding.*

The use of the broad-gauge trains to bring wounded back to
Remy Siding was carried out under the orders of the Fifth
Army Commander, as he was anxious to save the roads.

On the 31st July the walking wounded who went to No. 3
Canadian Casualty Clearing Station at Remy Siding came down
in great numbers by these trains and very few by road. They
consequently arrived in large batches, instead of coming down
in small numbers at a time by lorries and charabancs. If
the latter procedure had been carried out they would have

* This ambulance train was not required in Macedonia ; it was accepted
for France, and made its first trip on the 21st July 1917. The couplings,
however, did not prove suitable to run with the ordinary French stock, and
a breakdown occurred at St. Omer on the 18th August. The train was
consequently put out of action on the 12th September 1917, and was then
divided into two small trains to work in the front area until suitable steel
wheels could be supplied to replace the wooden centre wheels of the coaches.
These new wheels were fitted and the train returned to the ambulance train
service on 23rd February 1918.

THE BATTLES OF YPRES, 1917 161

arrived at the casualty clearing stations earlier and been
ready to fill the temporary ambulance train that was kept
waiting there, but which had been delayed until the broad-
gauge trains arrived from the front. The temporary ambulance
train had been waiting at Remy Siding since 10 o'clock in the
morning, and it took a long time before the large numbers
arriving by the broad-gauge train could be got ready for
entraining. The consequence was that the train did not leave
until 2.30 in the afternoon. Further trouble arose from the
fact that the empty supply trains bringing walking wounded
cases from Vlamertinghe ran into the ambulance train siding
at Remy, and by so doing prevented ambulance trains which
were garaged down the line, coming up until the siding was
clear. Consequently the congestion of the casualty clearing
stations at Remy Siding on the night of the 31st July/ 1st
August was excessive. The congestion could have been
relieved by evacuating to Second Army casualty clearing
stations at Godewaersvelde or to the hospitals at St. Omer
by road. All available resources were placed at the disposal
of the Fifth Army for this purpose by the D.G.M.S., but the
D.M.S. of the army did not take advantage of them. Instead,
he switched off the walking wounded from the XlXth Corps
to the casualty clearing stations at Mendinghem. Fifty cars,
however, were sent up to Remy Siding from St. Omer after
midnight of the 31st July. They would have arrived earlier,
but had to be employed in clearing patients to St. Omer from the
medical units at Hazebrouck, which was being severely shelled
in the afternoon and evening by long-range enemy artillery.

Light railways were employed to bring wounded to Remy
Siding from the advanced dressing stations at the Ecole de Bien-
faisance on the Ypres-Menin road, and from those at Lock 8
on the Canal and Woodcote House. Trains of four to eight
trucks, carrying 80 or 180 cases, ran hourly, the average time
taken on the journey from the Ypres-Menin road to Remy
being one and a quarter hours. They were used chiefly by the
Second Army after Remy Siding came under its control on
the 20th September. The Second Army had then two other
light railways with similar arrangements for evacuating
wounded to La Clytte and Kemmel. The hourly service,
however, broke down on account of damage to the line
during the battle of Polygon Wood, on the 26th September,
and only two full trains reached Remy Siding in consequence.

In order to avoid congestion at Remy Siding on the 4th
October the D.M.S. of the Second Army arranged that only

162 MEDICAL HISTORY OF THE WAR

half of No. 38 Ambulance Train should run from Ypres there
with light cases of the 1st Anzac Corps and that the other half
should run between Brandhoek and Godewaersvelde with the
casualties of the Xth Corps, but eventually both sections of
the train went to Godewaersvelde. In the attack on the
16th October some of these coaches were run from Dickebusch
to Bailleul ambulance train siding, the wounded being taken
from there to the casualty clearing station at Oultersteene by
road. On the 10th November, the trains also ran from
Reigersberg to Mendinghem. These various lines of evacuation
from forward areas to casualty clearing station centres are
shown in the sketch maps.

Shelling and Bombing of Medical Units.

During the whole period of these battles medical units of all
descriptions were constantly shelled or bombed by aircraft.
The shelling of the casualty clearing stations at Brandhoek
and the sites prepared at Elverdinghe has already been men-
tioned. At Hazebrouck the office of the D.M.S., Second Army,
and the medical units there, No. 15 CCS. and the New Zealand
Stationary Hospital, had to move elsewhere when the town
was shelled on the 1st August. One of the shells fell on No. 15
CCS. and completely destroyed part of its camp, but for-
tunately without causing casualties. The unit moved to
Ebblinghem, half-way between Hazebrouck and St. Omer,
and the New Zealand Stationary Hospital to Wisques, near
St. Omer.

The list of incidents on pages 163 and 164 represents approxi-
mately the extent of enemy attacks at this period on medical
units. They were of so exceptional a character as to give rise
to the belief that they were deliberate. The medical units
were indicated by the usual red cross signs on roofs of huts, and
also on large squares on the ground such as could be seen
by aircraft. The positions of casualty clearing stations had
also been notified to the enemy.

A photograph taken from the air appeared in a German illus-
trated magazine " Die Woche " on the 4th August showing a
British observation balloon moored near a medical unit and near
the sign of the Red Cross belonging to the unit. The illustration
drew the attention of the reader to the assumption that the
Red Cross had been placed there to protect a balloon which
was used in directing artillery fire. The photograph was sent
by the General Staff to the D.D.G.M.S., who identified it as
a photograph of the main dressing station of the XVIIIth

THE BATTLES OF YPRES, 1917

163

List of attacks on medical units of Second and Fifth Armies
July to November, 1917.

Date.

Unit attacked.

Locality.

Remarks.

3rd/4th July

No. 1 Australian

Bailleul . .

One bomb, killing a

CCS.

nursing sister.

6th/7th July

No. 11 CCS.

Bailleul Am-

Air raid 2.30 a.m.

bulance

Clear night. Airmen

Siding.

flew low. Dropped
7 bombs. Four
R.A.M.C. and 23
patients killed. Five
R.A.M.C, the chap-
lain and 63 patients
wounded.

13/14th July

No. 15 CCS.

Hazebrouck

Three bombs. No
casualties.

22nd July . .

No. 64 CCS.

Mendinghem

Four bombs 11 p.m.
No casualties.

22nd/23rdjuly

No. 2 Australian

Trois Arbres

Two A.A.M.C and

CCS.

2 patients killed.
Twenty patients
wounded. Four
bombs. Also shelled.

31st July . .

No. 46 Field Ambu-

Brandhoek

Shelled morning of 31st

lance.

July, and on and off

M.D.S. XlXth Corps.

since 19th June.

5th August . .

XVIIIthCorpsM.D.S.

Gwalia Farm

Shelled. Two R.A.M.C

lst/2nd Highland

and 1 A.S.C killed,

Field Ambulance.

25 other ranks
wounded. This was
the day following the
date of illustration in
" Die Woche." The
shelling was delib-
erate.

16th August

No. 3 Australian

Brandhoek

Bomb 10 p.m. One

CCS.

medical officer and
1 orderly A.A.M.C
killed.

17th August

No. 17 CCS.

Remy Siding

Four bombs. 9.20 p.m.
Casualties —

Killed. Wounded.

R.A.M.C. 6 13

Fatigue men7 15

Officers' ser-
vants 1 5

German

patients 13 6

No officer casualties.

17th August"

Bombed 9.30 to 10.30
p.m. from 300 to 400
ft. Two officers and

No. 61 CCS.

Dozinghem<

3 sisters wounded, 1
other rank killed and
3 wounded.

20th August

Four patients killed

and 18 wounded.

164

MEDICAL HISTORY OF THE WAR

Date.

Unit attacked.

Locality.

Remarks.

15th August"

Four officers and 4
other ranks wounded

17th August

on the 17th, and 1

No. 4 CCS.

Dozinghem -

officer, 1 "sister, and

19th August

28 other ranks on the
20th ; 6 other ranks

20th August

killed on the 20th.

20th August

No. 47 CCS.

Dozinghem

Fourteen other ranks
killed. Seven officers,
2 sisters, and 45 other
ranks wounded.

21st August

No. 44 CCS.

Brandhoek

Shelled all day. One
sister killed. Two
other ranks wound-
ed.

29th August"

Heavily shelled. Mar-
quees in course of

►

No. 10 CCS.

Elverdinghe*

erection riddled with
shrapnel. Red Cross
frames on ground.

31st August

One man wounded.

29th Sept.

No. 32 CCS.

Brandhoek

Bombs. No casualties.
Ten marquees des-
troyed.

1st October. .

No. 4 Stationary

Arques

Bombed. Four killed

Hospital.

and 5 wounded. Den-
tal centre destroyed.

20th October

Nos. 37and41C.C.Ss.

Godewaers-

Bombed. One sister

velde.

killed. Seven patients
and 8 R.A.M.C
wounded.

29th October

No. 61 CCS.

Dozinghem

Bombed 11.30 p.m.
One sister wounded,
3 patients killed.
Three patients and
1 R.A.M.C. wounded.

Corps at Gwalia Farm, long after the balloon had left the
vicinity of the dressing station, so that the photograph had
probably been taken before the series of attacks on the medical
units, and had no doubt been published in explanation of these
attacks at a later date. At least such was the conclusion
drawn from this unusual action on the part of the enemy.

The increasing frequency with which casualty clearing
stations were being shelled and bombed led to a memorandum
being issued to armies by the General Staff at the beginning
of August. The attention of Army Commanders was directed
in this memorandum to the fact that a tendency existed to
site casualty clearing stations too far forward, and pointed
out that the most forward of these stations should always be

THE BATTLES OF YPRES, 1917 165

well in rear of the balloon line, and as far away as possible
from ammunition dumps, aerodromes, railheads, or other
targets likely to draw the enemy's fire.

Provision for the Treatment of Wounds during the Battles.

A special feature of the work of the medical services during
these battles was the provision that had been made for the
surgical treatment of wounds in casualty clearing stations.
For this purpose the number of surgical teams and other
personnel sent to the Fifth Army was greatly in excess of
what had been possible during previous battles. A conference
was held by the D.G.M.S. on the 23rd June, in which the
D.D.G. discussed with the Ds.M.S. of Armies and of the
L. of C, and the D.D.M.S., XVth Corps, the general arrange-
ments for the forthcoming operations, especially with regard to
the additional surgical teams, for whom provision had been made
by the maintenance of reserve operating sets to enable three
extra operating tables being worked in each of twelve casualty
clearing stations. These sets were held in the base depot of
medical stores at Boulogne, and were supplemented by surgical
cloaks, sheets, and other operating-room equipment in twelve
sets maintained for the purpose, at the request of the D.G.M.S.,
by the Red Cross Advanced Stores at Ham-en-Artois near
Lillers.

On the 17th Jury, the D.G.M.S. had arranged for 15 surgical
teams and 100 R.A.M.C. other ranks to go to the Fifth Army
from the First Army, 10 surgical teams and 100 other ranks
from the Second Army, and 25 surgical teams and 200 other
ranks from the Third Army, in addition to 32 surgical teams
from hospitals on the L. of C. Subsequent orders, however,
restricted these numbers considerably, and the position on
the 1st August was that the Fifth Army had, in addition to its
own medical personnel, 57 surgical teams (25 from the Third
Army and 32 from the L. of C), 40 additional medical officers
(18 from the First Army, 14 from the Third Army, 2 from
No. 20 Field Ambulance, G.H.Q., 4 from No. 59 C.C.S.,
G.H.Q., and 2 from the L. of C), and 275 other ranks
R.A.M.C. (200 from the Third Army, 50 from No. 20 Field
Ambulance, and 25 from No. 59 C.C.S.).

These numbers varied from time to time during the battles,

but they represented more or less the proportion of additional

t surgical assistance sent to the casualty clearing stations engaged.

In the final phases of the battles of Ypres the additional
personnel in casualty clearing stations consisted of 46 surgical

166

MEDICAL HISTORY OF THE WAR

teams, 21 additional medical officers, and 195 other ranks
of the R.A.M.C. in the Second Army ; and 28 surgical
teams, 15 additional medical officers, and 140 other ranks
R.A.M.C. in the Fifth Army.

The accommodation in the Fifth Army casualty clearing
stations was expanded to provide for 1,000 casualties in each.
Consequently a very large number of huts and tent age, as
shown in the following table, was provided : —

Number of tents and huts in casualty clearing stations of the Fifth Army

during the battles of Ypres, 1917.
Hospital marquees —

Large

Small single

Small new pattern

E.P.I.P

Canadian pattern

Hospital small double

Hospital large I. P.
Ward huts

Bell tents

Ocher tents. .
Other huts

261

686

720

1,754

94
720

88
145

Large numbers of stretchers and blankets were also sent to
the armies engaged, in fact, during the year 1917, the ambulance
trains delivered to units in army areas 17,835 stretchers, as
follows : —

Stretchers supplied to Armies in 1917.

396

551

March

1,290

April

3,807

May-

186

June

1,507

July

1,908

August

1,638

September

2,168

October

2,234

November

1,050

December

1,100

Total

17,835

What became of the enormous number of stretchers sent
up to armies was at all times a mystery to those whose duty
it was to endeavour to recover them.

In addition large numbers of stretchers were held in army
dumps ; in fact by the end of the year the Second Army in the
Ypres area had a reserve of 19,443 stretchers in the casualty
clearing stations and in the six corps of which the army was
then composed.

THE BATTLES OF YPRES, 1917

167

Large reserves of blankets and stretchers were also held at
No. 4 Stationary Hospital, Arques, for delivery to army areas.
The reserve consisted of 2,300 stretchers and 6,000 blankets.
This reserve had been established at St. Omer in 1915, and
had been maintained ever since, but it was decided in the
middle of September 1917, that it would be no longer necessary
to maintain the reserve there. Steps were subsequently taken
by the D.G.M.S. to hold a large reserve in the casualty clearing
station at Hesdin, under his own control.

The Surgical Results.

It is interesting to compare the resources placed at the
disposal of the Fifth Army with the resources placed at the
disposal of other armies during previous battles, and also the
surgical results. They are shown in the following tables.

In order to compare surgical results, enquiry was made by the
D. D.G.M.S. as to the deaths amongst wounded in the hospitals
on the L. of C, who were received from the Second Army
during the first week of the battle of Messines, 7th to 13th June,
and from the Fifth Army during the first week of the Ypres
battles of 1917, 31st July to 6th August. The results were
as follows : —

Comparative Results of Wound Treatment in Second and Fifth
Armies, during the first week of Messines and Ypres Battles, 1917.

Second

Army,

Fifth

Army,

Messines,

Ypres

Battle,

7.6.17 to 13.6.17.

31.7.17 to 6.8.17.

No. of wounded admitted to C.C.Ss.

18,492

21,733

No. of deaths in C.C.Ss.

629

817

No. received in L. of C. hospitals

16,290

16,768

No. of deaths in L. of C. hospitals

162

177

No. of deaths on ambulance trains

No. of C.C.Ss. employed

No. of M.Os. employed : —

(a) from the army

116

110

(b) from other sources . .

100

179

216

289

Sisters employed

259

405

Other ranks employed : —

(a) Own army . .

1,342

1,173

(b) Other sources

443

1,389

1,785

2,562

X-ray outfits

Percentage of deaths to wounds : —

(a) In C.C.Ss

3-4

3-7

(b) In Base Hospitals . .

0-9

1-0

admitted

4-3

4-6

Percentage of M.Os. to the number

of wounded admitted to the

C.C.Ss

1-16

1-86

(10134)

168

MEDICAL HISTORY OF THE WAR

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THE BATTLES OF YPRES, 1917

169

The percentage of deaths amongst wounded on the L. of C.
was therefore practically 1 per cent, amongst those from the
Second Army, against 1-05 per cent, amongst those from the
Fifth Army, but the deaths on the ambulance trains were
about three times less in the battles of Ypres than in the battle
of Messines Ridge.

As regards surgical operations the following table shows the
number of wounded admitted into casualty clearing stations
of the Second and Fifth Armies between the 31st July and
16th November, 1917, with the numbers operated on in them.

Statistics of the number of wounded on whom operations were
performed in the Casualty Clearing Stations of the Second
and Fifth Armies between 3lstjuly and 16th November 1917.

Casualty Clearing Stations.

Number
admitted.

Number
operat edon.

6,016
4,673
5,002
5,816

Percentage
operated on.

Remy Siding Group —
No. 2 Canadian
No. 3 Canadian

No. 10

No. 17

20.497
18,721
17,343
17.361

29-6
25-0
29-0
30-2

Nine Elms Group* —
No. 3 Australian
No. 44

7,073
8,234

2,107
2,377

30-0
29-0

Brandhoek —

No. 32

5,349

1,253

23-9

Godewaersvelde Group —
No. 37 . . . .

No. 11

No. 41

6.572
6,883
6,823

1,373
2,000
2,028

22-5
30-5
30-0

Bailleul Group — -

No. 2

No. 53

No. 1 Australian
No. 2 Australian

3.267
5.026
4,011
3,167

878
1,212
2,111
1,474

29-0
40-0
51-0
46-0

Dozinghem Group —

No. 4

No. 47

No. 61

11,447
12,233
10,932

3,811

4,464
4,183

35-0'
36-0
38-0

Mendinghem Group —

No. 12

No. 64

No. 46

13,109
11,179
12,637

3,603
3,490
3,552

28-0
30-0
27-5

* At Brandhoek during August.

170 MEDICAL HISTORY OF THE WAR

It will be observed that in casualty clearing stations receiving
comparatively small numbers of wounded the percentage of
operations was naturally very much higher than in those
receiving large numbers of wounded ; the greatest percentage
of operations being 51-0 in No. 1 Australian CCS. of the
Bailleul group, out of 4,011 admissions, and the smallest 25-0
per cent, in No. 3 (Canadian) CCS., out of 18,721 admissions,
although it ought to be stated that the majority of admissions
into No. 3 (Canadian) were walking wounded cases and there-
fore not requiring the same extent of operative interference.
In the hospitals specially detailed for seriously wounded, such
as No. 4 at Dozinghem, the comparatively high number of
35 per cent, was operated upon out of 11,447 admissions, but
No. 32 CCS. at Brandhoek, which received severely wounded,
had the small percentage of 23 -9 per cent, out of 5,349 admiss-
ions, although it must be noted that after August 21st this
casualty clearing station was receiving walking wounded only.

The total number wounded and the number of operations,
to which these figures refer, were 199,864 wounded and 61,225
operations, or 30-6 operations amongst every 100 wounded
admitted. The operations included all operations undertaken
for cleansing of wounds and excising damaged tissues, in
slightly wounded as well as in the more severely wounded.

The Mustard Gas Attack.
In addition to the wounded, numbers of cases injured by
mustard gas came to the casualty clearing stations. The
first mustard gas attack took place in the Ypres area on the
night of the 12th/13th July after a heavy bombardment, 1,800
cases being admitted to the casualty clearing stations on the
13th July. Large numbers of gassed cases were again admitted
on the 11th and 12th September, and on the 17th October it
was stated that one- third of the casualties occurring at that
time were due to gas, and that the case mortality was higher.

Analysis of Nature of Wounds.
An attempt was made during these battles to analyse the
nature of the wounds admitted during twenty-four hours on
the 21st and the 27th September, with the following results : —

Among 10,789 British wounded on the 21st September —
77 were hand grenade wounds.
17 bayonet wounds.
2,933 bullet wounds.
2,142 shrapnel wounds.
3,867 high explosive shell wounds.

209 gassed.
1,544 uncertain causes.

THE BATTLES OF YPRES, 1917 171

Among 756 German wounded —
264 were bullet wounds.
363 shell wounds.
120 uncertain causes.
9 gassed.
On the 27th September, of 2,932 British wounded admitted in the
twenty-four hours : —

16 were hand grenade wounds.
8 bayonet wounds.
600 bullet wounds.
836 shrapnel wounds.
1,325 high explosive shell wounds.
106 gassed.
41 uncertain causes.
and of 88 German wounded —
22 were bullet wounds.
52 shell wounds.
2 gassed.
12 uncertain causes.

Sickness during the Battles.

The sickness during the period of the battles was com-
paratively slight. Most of the patients were treated in
divisional or corps rest stations, although an average of 0-3 to
1*0 per cent, of strength had to be evacuated weekly to the
base. The wastage from sickness was thus considerably less
than wastage from wounds. In the Fifth Army, for example,
the records show that 1,805 officers and 40,899 other ranks
were sent to the base sick, as compared with 4,159 officers and
100,688 other ranks wounded between the 1st July and the
10th November 1917.

CHAPTER IX.

THE BATTLE OF HILL 70, AUGUST 1917.

The Battle of Hill 70 was fought between the 15th and
25th August, 1917, by the 2nd and 1st Canadian Divisions
of the Canadian Corps in the First Army area, and resulted in
the capture of Hill 70, which had been reached but not held
in the Battle of Loos, and also the mining suburbs on the
outskirts of Lens. The fighting was of an exceptionally severe
character, and the casualties were heavy, especially from
mustard gas.

The 2nd Canadian Division medical services were directed
by the A.D.M.S., Colonel H. M. Jacques, who had established
a main dressing station with No. 4 Canadian Field Ambulance
under Major Macdonald at Fosse 10, and a main dressing
station for walking wounded by No. 6 Canadian Field Am-
bulance under Lieut. -Colonel Murphy at Aix-Noulette. There
were both a narrow-gauge and a broad-gauge railway running
up towards the positions from which the attack was launched,
and an advanced dressing station was placed at each railhead,
relays of bearers bringing the wounded back from the regi-
mental aid posts to these positions. From the advanced dressing
stations both sitting and stretcher cases went back by rail
to Fosse 11, chiefly by the narrow-gauge railway, and from
there the stretcher cases were taken by motor ambulance
cars to the main dressing station at Fosse 10, and the walking
wounded by the narrow-gauge railway to Aix-Noulette. The
assistance afforded by the use of this line was so great that
it became unnecessary to use lorries or other vehicles for the
conveyance of the walking wounded. The plan of evacuation
worked throughout smoothly and without hitch, and no delay
or congestion occurred at any point. No. 8 M.A.C. and
fifteen motor lorries were employed in evacuating from the
main dressing stations to No. 22 CCS. at Bruay.

The 2nd Canadian Division was again engaged on the 21st
August, when the arrangements were of a similar nature and
worked equally well. Casualties during this attack were
heavier, over 700 being admitted to the main dressing station
at Fosse 10, and about eighty to Aix-Noulette.

THE BATTLE OF HILL 70, AUGUST 1917 173

The 1st Canadian Division (Colonel Wright, A.D.M.S.)
had relieved the 6th Division before the attack and taken
over the field ambulance posts established by it. Much work
had been done by the latter division in preparing advanced
dressing stations and regimental aid posts in and around Loos,
Maroc, Philosophe and the forward area in deep dugouts and
cellars, which were well protected, conveniently placed and
capable of accommodating over 500 stretcher cases. The
main dressing station was situated in a school at Noeux-les-
Mines, where there was spacious and well-planned accommo-
dation for receiving and treating large numbers of wounded
The walking wounded dressing station was at Barlin.
Each battalion on going into the line was furnished with
twenty-five stretchers and a box of medical comforts supplied
by the Canadian Red Cross Society. The clearing from the
regimental aid posts was carried out by two of the field am-
bulances, augmented by bearers of the third field ambulance.
One hundred extra bearers were also detailed from each of the
two attacking brigades to assist in bringing wounded to the
advanced dressing stations, and men of the pioneer battalion
also helped in carrying the wounded. Roads leading to the
front were in such good condition and had escaped destructive
shell-fire to such an extent that the motor ambulance cars
were able to run into the most advanced stations, greatly
relieving the work of the bearers. There was a tram-line,
but it had been destroyed and was of little use.

On the night of the 17th/ 18th August, the enemy heavily
bombarded the 1st Canadian Division area with gas shells,
and rendered the work of clearing the wounded very difficult,
as well as causing many casualties amongst the bearers. As
soon as it was ascertained that mustard gas shells were being
thrown prompt measures were instituted at the advanced
dressing stations to combat their effects. The patients were
stripped in the open air and then brought into the advanced
dressing station, where they were bathed from head to foot in
soda solution, their eyes washed with the solution (one per cent.),
and covered with gauze, and each patient given thirty grains
of soda bicarbonate internally. The patients were then
dressed in pyjamas and evacuated as stretcher cases. Only
a few required inhalation of oxygen. The value of this early
treatment was shown by the good condition in which the
patients arrived at the casualty clearing stations.

No. 12 M.A.C. cleared from the main dressing station to the
casualty clearing stations, the severely wounded going to

174 MEDICAL HISTORY OF THE WAR

No. 7 C.C.S., then established at Bracquemont, a suburb of
Noeux-les-Mines. The walking wounded were sent to No. 22
CCS. at Bruay in lorries.

As Maroc and its vicinity were heavily shelled on the first
day of the attack, the advanced dressing station there was
not used, and evacuation took place chiefly through the ad-
vanced dressing station at Philosophe.

The casualties in the 1st Canadian Division were heavy.
From the commencement of the attack on the night of
17th/18th August up to 5 p.m., on the 18th August, 75
officers and 2,546 other ranks had been admitted to its field
ambulances, in addition to 8 German officers and 249 German
other ranks, and during the succeeding night 8 officers and
390 other ranks had been collected and casualties were still
coming in.

The operations of the 1st and 2nd Canadian Divisions were
carried out to relieve pressure against the British in the Ypres
salient, and were conducted against a much superior force of
the enemy, thus explaining the heavy casualty list.

CHAPTER X.

THE DUNKIRK-NIEUPORT AREA, 1917.

THE front line of the coast sector taken over from the French
by the XVth Corps on the 11th June, 1917, extended from
the sea to St. Georges on the Yser Canal. The line from the sea
was on the right bank of the canal near Lombartzyde, and
then crossed it to St. Georges, which was on the left bank.
At the time when the area was taken over, two divisions, the
32nd on the right and the 1st on the left, occupied this line,
with the 66th Division in reserve.

The area consisted of two zones of country, dunes and
sandy beach on the north, and fiat ground intersected with
canals, drains or dykes on the south. The town of Nieuport
was practically in the front line. The evacuation of wounded
from the area was difficult, as many of the roads were much
exposed to fire and direct observation. Carries by bearers
were long and tedious, especially through the dunes and
sands, and relays had to be arranged. Walking wounded
on the left sector, however, could make their way back on
the firm sands of the coast.

The front line covered a distance of some four miles. Along
it seven regimental aid posts of varying capacity were
established, some sheltering six and others as many as twenty
stretcher cases. The aid posts were capable of withstanding
any artillery fire except a direct hit by a large shell, and were
completely protected against gas. There were two collecting
posts, both on the right sector close to the regimental aid
posts. A bearer sub-division of a field ambulance was posted
to each.

There were three advanced dressing stations, so placed that
they could be accessible by cars. They were all in extensive
cellars capable of withstanding direct hits by 8-in. shells,
two of them on the left sector at Nieuport Bains and Oost
Dunkirk Brewery, with a total capacity for 250 stretcher
cases, and the third at Nieuport, for sixty stretcher cases.
The last had electric light and an electric fan, and all were
fully protected against gas. Dugouts in the dunes on the
coast near Groenendijk Plage were used as collecting posts.

176 MEDICAL HISTORY OF THE WAR

There were three walking wounded collecting stations.
Two were for the left sector at Oost Dunkirk Bains and Oost
Dunkirk Town, each serving a different route of evacuation.
The third was for the right sector and was two miles outside
Nieuport on the main Nieuport-Coxyde road. The routes of
evacuation from the left sector were by the coast route, and
by a Decauville line running along an inland road to Coxyde.
The right sector had three routes of evacuation from Nieuport
to the Oost Dunkirk road, one via Triangular Wood, another
via Piste des Zouaves, and the third via Pelican Bridge and
Wulpen Bridge. A Decauville line ran along all these roads,
and all lines of evacuation joined up at the Oost * Dunkirk-
Coxyde road, whence the route was to the corps main dressing
station. Wheeled stretchers were used to bring wounded to
the advanced dressing stations.

The D.D.M.S. of the XVth Corps, Colonel Newland, on
arrival in the area formed a corps main dressing station at
De Groote Kwinte Farm, where there had previously been a
French medical unit, on the road between Furnes and Coxyde.
It was opened on the 18th June. This corps main dressing
station was seven miles from the front line, and had ten Adrian
huts and a large number of hospital marquees. It also
had a large operating theatre, and was eventually equipped
to receive 1,200 at one time, special arrangements being made
in it for gassed cases. The more serious cases amongst the
wounded went direct, however, to the casualty clearing
stations. A complete field ambulance formed the personnel
of the corps main dressing station.

Only two casualty clearing stations, No. 1 Canadian and
No. 24, went with the XVth Corps to the coast area. They
were opened at Oosthoek, near Adinkerke, where there had
been a hutted hospital presented to the French and maintained
by an American lady, Mrs. Turner. The hospital had 16 huts
in all, 8 of which were ward huts for 18 beds each. They were
taken over by No. 1 Canadian Casualty Clearing Station,
British huts and tentage being added* No. 24 was opened
some time afterwards near No. 1 Canadian at Oosthoek in
Nissen huts.

When Surg.-General O'Keeffe arrived with the Fourth Army
Headquarters, three more casualty clearing stations were
brought up, Nos. 36, 39, and 34. No. 36 was opened in a
portion of a large sanatorium on the coast at Zuydcoote, the

* Mrs. Turner followed the French troops to Roosbrugge, where Nissen
huts were given to her in exchange for those left at Oosthoek.

THE DUNKIRK-NIEUPORT AREA, 1917 177

greater part of the building being retained as a hospital by
the French. No. 39 was established in tents at Oosthoek
and opened at the beginning of August, at the same time as
No. 24, the huts for which were not ready until then. No. 34
did not arrive in the area until later. It was sent at first to
St. Idesbald, on the coast about one and a half miles north-
east of La Panne, for the reception of infectious cases and
nerve cases (N.Y.D.N.). There was an admirably equipped
Belgian Isolation Hospital already there in ten pavilions and
huts, and the intention was to take these over.

The site of the three casualty clearing stations at Oosthoek
was on flat low-lying ground liable to become very wet, and
the huts were consequently well raised on piles off the ground,
and roads and duck-board paths were made. There was a good
ambulance train siding at Oosthoek, sufficient to garage, if
necessary, two ambulance trains. The accommodation in
each of these three casualty clearing stations was approximately
1,000. No. 36 C.C.S., at Zuydcoote, could also accommodate
1,000 and St. Idesbald Hospital 200, or with the addition of
tents 750. St. Idesbald, however, was too far forward. No. 34
C.C.S., which arrived there in August, was consequently
closed, owing to danger from artillery fire, before any patients
had been admitted, and was eventually opened in tents
outside the Zuydcoote sanatorium on the 26th August.

Dr. Depage's Belgian hospital at La Panne, the " Ambulance
Ocean," and the Society of Friends' Queen Alexandra Hospital
of 160 beds at Malo-les-Bains, placed beds at the disposal of the
British. These were hospitals for the Belgians, but the latter,
which had an agreement with the B.R.C.S. of the 29th July,
1915, had been under the administration of the D.M.S.,
L. of C, for the reception also of sick from British labour corps
at the Dunkirk port. Serious wounds of the head, chest, and
abdomen were, by arrangement with Dr. Depage, sent to his
hospital on payment of three francs for each patient daily.

A large corps rest station to accommodate about 2,000 was
established by the XVth Corps, near Zuydcoote.

There was thus ample accommodation for the sick and
wounded of the area provided there was adequate means of
evacuation. Evacuation was possible by road or canal to
St. Omer and Calais as well as by ambulance trains. Surg.-
General O'Keeffe's estimate of maximum requirements for
evacuation by these three routes was six ambulance trains,
carrying a total of 4,000, two motor ambulance convoys
making two journeys daily to St. Omer or Calais, carrying a

178 MEDICAL HISTORY OF THE WAR

total of 1,200, thirty charabancs carrying 800 sitting cases,
and 12 ambulance baLges, carrying 360 lying cases. This
estimate was made on the assumption that the number of
wounded on the first day of an active offensive on the coast
front would amount to 10,000, and on the second day 5,000.

Two motor ambulance convoys, No. 26 and No. 10, and
three ambulance flotillas, Nos. 3, 4, and 5, were allotted to him,
No. 3 having been brought up from the Somme to Calais on the
29th July. Nos. 4 and 5 arrived at Dunkirk and Adinkerke
on the 19th July, The barges took twelve hours to reach
St. Omer, the distance from Adinkerke to Dunkirk being
about twelve and a half miles and that from Dunkirk to
St. Omer through Bergues and Watten thirty-five and a
half miles.

Other medical units in the Dunkirk area were two mobile
laboratories (No. 12 Hygiene and No. 19 Bacteriological),
an advanced depot of medical stores, No. 13, a mobile X-ray
unit, and a mobile dental unit. They were all at Malo-les-Bains
except the bacteriological laboratory and X-ray unit, which
were placed at Oosthoek and Zuydcoote respectively. There
were also three sanitary sections.

Medical arrangements for British Artillery with the
Belgians.
Certain British artillery units were attached to the Belgian
Army in the Dixmude front, and when the British held the
coast sector a section of a field ambulance was detached for
duty with it. The arrangements were that the sick and
wounded of the artillery would be collected to an advanced
dressing station and collecting post opened by it and trans-
ferred to the casualty clearing stations in the British coast
area. Six motor ambulance cars were attached to it for
bringing sick and wounded from the artillery aid posts,
seventeen of which were formed by officers in medical charge
of brigades of artillery and groups of heavy artillery. Five
of the posts were reinforced by additional R.A.M.C. personnel
and were provided with wheeled stretchers. They were in
telephone communication with the group of motor ambulance
cars. The advanced dressing station was at Avecappelle on the
Dixmude-Furnes road, with a personnel of two medical
officers and bearer squads and with four motor ambulance cars.
The collecting post was established at Zotenay, also on the
Dixmude-Furnes road, with one medical officer, bearer squads
and two motor ambulance cars.

THE DUNKIRK-NIEUPORT AREA, 1917 179

In response to a telephone or other message stating the
number and particulars of casualties requiring to be removed,
motor ambulance cars were to be sent from the XVth Corps
main dressing station to remove sick and wounded to it.
Arrangements had also been made with the Belgian authorities
for casualties amongst British troops being received into
Belgian dressing stations and Belgian casualties into the
Biitish dressing stations, according to circumstances.

Medical Work during operations in the Coast area.

Although no active operations of any magnitude were
undertaken by the Fourth Army and XVth Corps on the
coast, the narrow strip of country occupied by the British
was constantly shelled and bombed and subjected to gas
attacks. In addition, the enemy launched a determined
offensive against the British front on the 10th July. The
attack began at 7-45 in the evening after a heavy bombard-
ment, and the 1st Division, holding the left sector, was driven
back over the Yser Canal, two of its battalions being wiped
out. Two R.A.M.C. officers of the division were missing,
Captains Ward and Hayes. The 32nd Division, which was
at first also driven back, held out. All the bridges between
Nieuport and the sea were destroyed by the preliminary
bombardment, and great difficulty was experienced in bringing
cases back, in fact very few casualties were cleared from that
portion of the front ; but Captain H. A. Pallant, the officer
in medical charge of the 1st Battalion of the Loyal North
Lancashire Regiment, did good work in swimming the Yser
and assisting back men who could not swim.

The total number of casualties admitted to the medical units
during this attack up to the 12th July was 39 officers and
1,247 other ranks, of whom 21 officers and 741 other ranks
were from the 32nd Division, and 13 officers and 222 other
ranks from the 1st Division, the remainder coming from army
and corps troops.

The enemy attack was not continued after the 12th July,
but back areas were constantly shelled and bombed.

The advanced dressing station of the 32nd Division received
three direct hits, one from a 12-in. shell which wrecked one of
the entrances.

Malo-les-Bains and Dunkirk were frequently shelled by a
15-in. long distance naval gun. On the 27th June the shelling
commenced m the early morning, and shells fell every seven
minutes in Malo-les-Bains. One of them by a direct hit at

180 MEDICAL HISTORY OF THE WAR

5-30 a.m. destroyed the Casino, which was occupied as offices
of the XVth Corps Headquarters, killing twelve and wounding
twelve of the clerks. The bombardment ceased at 11-30 a.m.,
after some forty-nine shells had been thrown. The wounded
were taken to the Queen Alexandra Red Cross Hospital. The
headquarters of the corps then moved to Bray Dunes Plage.

Dunkirk was again shelled by the same naval gun on the
last day of September, most of the shells falling in the docks.
La Panne hospital was shelled on the 1st and 11th September.

The corps main dressing station at Groote Kwinte Farm
was heavily shelled in the afternoon of the 27th August, twenty-
five shells falling in or near it in fifty minutes. The patients
were rapidly evacuated, the only casualty being the Roman
Catholic chaplain, who was killed.

The D.M.S. of the Fourth Army then decided that as the
casualty clearing stations at Oosthoek were close up to the
front and on the Decauville railway running from the front,
a new main dressing station was unnecessary. All serious
cases were then sent direct to the casualty clearing stations,
from the advanced dressing stations, and slight cases to the
XVth Corps rest station.

The casualty clearing stations at Oosthoek had to be closed
in September on account of the constant shelling in their
vicinity. Although they were not actually hit, shells had
dropped quite close to them on the 4th September, and the
nursing sisters, forty-five in number, were withdrawn to
No. 10 Stationary Hospital at St. Omer. Shelling continued
during the day, and several fell near No. 24 C.C.S., although
not actually dropping on it. Four hundred and seventy-six
patients were then evacuated by train to the base, and 220 to
No. 34 and No. 36 C.C.Ss. at Zuydcoote.

Enemy air raids were especially active in September, 270
bombs having been dropped on the last day of the month in the
back area. The number of wounded during the month was
62 officers and 1,713 other ranks, chiefly from bombs and
shell-fire. Air raids were also very frequent in October, as
many as eleven out of fourteen occurring in the last fifteen
days of the month.

Mustard gas attacks were commenced against the XVth
Corps front about the same time as mustard gas was used
against the Fifth Army front. They were of a specially
severe chaiacter. The first cases were reported on the 11th
July, and between then and the 25th July over 2,350 gas
casualties had occurred, including 11 officers and 49 other

THE DUNKIRK-NIEUPORT AREA, 1917 181

ranks of the R.A.M.C. The 49th Division, suffered so
severely between the 22nd and 26th July, that it had to be
withdrawn from the line. These attacks were continued in
September and during the remainder of the period of
British occupation.

Medical preparations for combined Naval and Military
operations.

While the two divisions occupying the front line were thus
subjected to constant gas attacks, and the reserve divisions,
corps and army troops in back areas were being shelled and
bombed almost daily, the 1st Division was isolated at Le
Clipon, in a quiet area seven miles west of Dunkirk, under-
going special training for a combined naval and military attack
on the coast behind the enemy lines.

The division went into training in the latter half of July,
and no patients were allowed to be evacuated from the camp
area for reasons of secrecy. A special hospital was then
equipped to accommodate 250 patients in order to retain all
sick of the division when in the training area. The hospital
was manned by No. 1 Field Ambulance.

With a view to preparing them for the contemplated landing
on the coast, the field ambulances were trained physically and
in carrying loads, negotiating obstacles, loading and off-loading
motor ambulances with special loads, packing panniers with
modified contents, swimming and life-saving, semaphore
signalling, night operations, and loading and off-loading from
pontoons as a unit and in conjunction with the brigades to
which the field ambulances might be attached.

The scheme involved the employment of a field ambulance
with each brigade, each field ambulance consisting of 7 officers,
164 other ranks, and 6 mechanical transport drivers, with
additional dressings and comforts. Two motor ambulance
cars, 2 motor cycles, 4 handcarts, and 1 bicycle were to be
taken with each field ambulance, but no other kind of transport
was to be made available. A field day was held on the 19th
September with one of the brigades, and 300 casualties handled
satisfactorily.

The camp was given up towards the end of October.

The transfer of British units from the Coast area.

The British then abandoned the coast area. The D.M.S. of
the Fourth Army closed his office at Malo-les-Bains on the
5th November, moving to Dury, near Amiens, but when the

182 MEDICAL HISTORY OF THE WAR

D.M.S., Second Army, proceeded with the Second Army
headquarters to Italy on the 16th November, Surg.-General
O'Keeffe took over his duties in the Ypres area. After he left
Dunkirk, the D.D.M.S., XVth Corps, remained in adminis-
trative medical charge of the area, until it was finally
handed over to the French. Colonel Newland handed over
his duties as D.D. M.S. of the XVth Corps to Colonel Whaite
and became D.D. M.S. of the XlVth Corps, which was moving
to Italy, and on the 17th November the XVth Corps area
was handed over to the 36th French Corps.

The two casualty clearing stations, Nos. 34 and 36, at
Zuydcoote remained open in October. When they were closed
their equipment was brought to St. Omer in the ambulance
flotilla barges.

No. 1 Canadian Casualty Clearing Station went to the First
Army, and opened at Ruitz. Two of the flotillas, Nos. 3 and 4,
were demobilized on the 18th November.

No. 24 and No. 39 C.C.Ss., were transferred to Italy, and
No. 34 CCS. and other medical units to the Fifth Army
south of the Somme, with the exception of No. 36 CCS.,
which after remaining parked for some time at St. Omer was
transferred at the request of the Fourth Army Commander to
Roosbrugge.

CHAPTER XI.

THE CAMBRAI OPERATIONS IN 1917.

THE preparations for the battle of Cambrai, commenced on
the 20th November 1917, were conducted with the utmost
secrecy by the G.O.C. and staff of the Third Army. There
was no preliminary bombardment, the attack on the enemy
defences being heralded by large numbers of tanks smashing
through his wire, followed by an advance of infantry under
an artillery barrage. The cavalry were in readiness to take
advantage of any gap which might enable them to go through.
French cavalry had also been brought up to co-operate with
the British cavalry.

The sector selected for the attack was a front of some 3 to
4 miles of the Hindenburg line, from Gonnelieu to the Canal
du Nord, just north of Havrincourt Wood. The first objective
was to secure the Bourlon Wood north of the line, in the angle
formed by the Cambrai-Bapaume and Cambrai-Arras roads ;
the enemy near Cambrai was then to be rounded up.

The corps engaged in the battle were the Hlrd and IVth
and the Cavalry Corps.

At the time of the first attack the divisions of the Hlrd
Corps were the 6th, 12th, 20th, and 29th.

The IVth Corps divisions were the 36th, 56th, 62nd, and
51st, and those of the Cavalry Corps the 1st, 2nd, 3rd, 4th
(Indian), and 5th (Indian) Cavalry Divisions.

Before the operations ceased the Hlrd Corps was reinforced
by the 36th, 61st, Guards, and 9th Divisions, and the IVth
Corps also by the 9th, Guards, 40th, 2nd, and 47th Divisions,
some of these divisions being moved from one corps to the
other as the situation demanded.

The Vllth Corps was on the right of the Third Army
opposite Vendhuille with its 55th Division on the right of the
Illrd Corps.

The Vth Corps had joined the Third Army from the Flanders
Front just previous to the battle and was in reserve.

The Vlth Corps was on the left of the IVth Corps, with the
XVIIth Corps further north on the right of the First Army.

10134 P

184 MEDICAL HISTORY OF THE WAR

The divisions engaged at the commencement of the battle
were the 12th, 20th, 6th, 51st, 62nd, and 36th Divisions, with
the 29th and 56th in support. The 3rd and 16th Divisions of
the Vlth Corps made a subsidiary attack at Bullecourt further
north.

The initial attack resulted in an advance of four and a half
miles, the Canal de St. Quentin and the Escaut being crossed
at Marcoing. Masnieres on the opposite bank was occupied.
A squadron of the Canadian Cavalry Brigade of the 5th (Indian)
Cavalry Division went through and crossed the canal, but
eventually withdrew at nightfall, after the greater part of its
horses had become casualties.

The advance was continued on the 21st November, dis-
mounted regiments of the 1st and 5th (Indian) Cavalry
Divisions taking part. The outskirts of Bourlon Wood were
reached that day.

Fighting was resumed on the 23rd November by the 56th,
40th, and 36th Divisions and dismounted cavalry of the 1st
Cavalry Division, and Bourlon Wood was captured. Bourlon
village was occupied the following day, but was recaptured by
the enemy on the 25th November. On the 27th November a
final effort was made to secure the position held in Bourlon
Wood and ridge by the Guards Division and the 62nd Division,
assisted by tanks.

The British offensive then ceased, but during the last days
of November the enemy commenced his preparations for a
counter-offensive, which he launched on the 30th November.
The right of the British line south of Gonnelieu was attacked
in flank and overwhelmed, the enemy advancing beyond the
village of Villers Guislain, until held up by the 5th (Indian)
and 4th (Indian) Cavalry Divisions, the Guards and the 61st
Divisions, which came up from reserves. The divisions
attacked were the 55th, 12th, 20th, and 29th Divisions, but
the 55th on the right flank and the 29th on the left held their
ground, the former falling back slightly, the latter not at all.
Further north a massed German attack was launched between
Bourlon Wood and the Canal du Nord against the 47th, 2nd,
and 56th Divisions. The fighting was of the fiercest description,
but these old army and Territorial divisions held out against
overwhelming numbers of the enemy. An attack was also
made in the centre of the British salient at Masnieres, where
the 29th Division, as already noted, maintained its ground.
Fighting continued on the 1st and 2nd December, chiefly in
the neighbourhood of Masnieres. The enemy's attack then

MalbyftSons.Lrth.

THE CAMBRAI OPERATIONS IN 1917 185

became exhausted and, from the 4th December, fighting died
down. The British line, however, was withdrawn to more
secure positions on the following days, the new line running
from north of Gonnelieu to the west of Marcoing, north of
Flesquieres and back to a point in the original British line
south of the Bapaume-Cambrai road. South of this, a portion
of the original British line was in the enemy's possession, the
new British line running west of the villages of Gonnelieu and
Villers Guislain.

General Medical Preparations for the Battle.

The casualty clearing stations of the Third Army at the
time of the attack were Nos. 21 and 48 at Ytres, Nos. 5 and 55
at Tincourt, Nos. 45 and 49 at Achiet-le-Grand, Nos. 3 and 29
at Grevillers, Nos. 20 and 43 at Boisleux-au-Mont, and Nos. 19
and 8 at Agnez-les-Duisans, with No. 56 in the back area at
Edgehill, and the Lucknow at Peronne-la-Chapellette. Some
of the Third Army casualty clearing stations had just been
moved to Italy, namely, No. 9 from Aveluy, and No. 38 from
Bray.

The stationary hospitals at Frevent, St. Pol, Doullens, and
Gailly, namely, Nos. 6, 12, 3 (Canadian), and 41, remained in
the respective positions which they held during and after the
battles of Arras.

The chief problem which had to be faced was the reinforce-
ment of these casualty clearing stations with surgical teams and
extra equipment, without creating an impression that important
operations were impending.

The Army Commander was insistent on the maintenance of
absolute secrecy, as any movement of reinforcements of casualty
clearing stations that was observed by the enemy would indicate
preparations for battle. Consequently only his D.M.S.,
Surg.-General Irwin, was kept informed of his intentions.
Surg.-General Irwin had, however, informed his Army Com-
mander that it would be impossible for him to obtain the
necessary surgical help in his casualty clearing stations without
the D.D.G.M.S. at G.H.Q. also being taken into his confidence.
Permission was then given for him to see the D.D.G. at G.H.Q. ,
on the understanding that the latter alone should be informed
of the intentions of the Third Army Commander. Although
the operations were planned in association with the General
Staff at G.H.Q. no information whatever reached the Director-
General's office or D.D.G. on the subject from either the

186 MEDICAL HISTORY OF THE WAR

Adjutant-General or General Staff, but the D.D.G., Surg.-
General W. G. Macpherson, had an interview with the General
Staff, and let it be known that he was fully cognisant of the
preparations that were being made. He was then given a free
hand by the General Staff to act as he thought best to bring
up the necessary reinforcements to the casualty clearing
stations in a manner which would prevent any knowledge of
the impending attack leaking out. Fortunately at this time
there was considerable movement of medical units to Italy, and
the D.D.G. took advantage of this fact, and of the fact that
the operations in the Flanders area had ceased, to order the
return of surgical teams of the Third Army to their units, and
to obtain further teams by instructing Ds.M.S. of other armies
and of the L. of C. to send medical officers and other ranks to
No. 6 Stationary Hospital, Frevent, with a view to their being
transferred to another area, thus creating the impression that
they were joining the Italian Expeditionary Force. He also
ordered the two reserve outfits, not yet distributed to casualty
clearing stations, from Boulogne to Frevent for the same
purpose. The D.M.S. of the Third Army was informed
immediately this personnel arrived at Frevent, and transport
was then sent by him to remove and distribute the surgical
teams and other personnel to the casualty clearing stations to
which they were allotted. In this way the casualty clearing
stations were reinforced by surgical teams who had no know-
ledge until they arrived at the casualty clearing stations on the
eve of the battle that any active operations were contemplated
in the Third Army.

The number of teams sent to the Third Army in this way
from other armies and from the L. of C, and the additional
medical nursing services and other personnel is shown in the
table on the next page.

In addition to the teams, belonging to his own casualty
clearing stations, which had been temporarily attached to
casualty clearing stations of the Fifth and Second Armies for
the Battles of Ypres, the D.M.S.'s original requirements were
three teams for each of the casualty clearing stations at Ytres
to arrive on the 17th, 2 teams for each of those at Grevillers
to arrive on the 18th November, and 1 team each for the two
casualty clearing stations at Tincourt, for No. 20 at Boisleux-
au-Mont and for the two casualty clearing stations at
Achiet-le-Grand to arrive on the 19th November. It will be
seen from the table, however, that the distribution of teams
was slightly different.

THE CAMBRAI OPERATIONS IN 1917

187

Table showing additional Surgical Teams and Medical
Personnel attached to Casualty Clearing Stations of
the Third Army on 20th November 1917.

Casualty Clearing
Station Centre.

Casualty
Clearing
Station.

Number of

additional

surgical

teams.

Additional medical
personnel.

M.Os.

Sisters.

O.R.

Grevillers

Tincourt

Ytres

Agnez-les-Duisans

Boisleux

Achiet-le-Grand

Edgehill

Peronne la Chapellette

No. 3
No. 29

No. 5
No. 55

No. 21
No. 48

No. 8
No. 19

No. 20
No. 43

No. 45
No. 49

No. 56

Lucknow

2
3

2
2

3
3

nil
nil

nil

nil
nil

7
11

5
5

17
12

nil
nil

4
3

nil

8
14

3
9

15
10

nil
nil

nil
2

nil
3

nil

52
52

37
29

83
67

nil
nil

26
36

nil

The surgical teams were provided mainly by other armies, whilst the sisters
came from the base and lines of communication hospitals, also from the
stationary hospitals attached to the Third Army.

Additional medical officers and other ranks were provided by the field
ambulances of the corps from which the casualty clearing stations were to
receive casualties.

The generalpolicy was that, while teams arriving from casualty
clearing stations in other armies should take with them a set
of equipment,* teams from the hospitals on the L. of C. would

* Each team from other casualty clearing stations was to bring with it
the following operating requirements : —

1 operating table.
10 scalpels.

10 artery forceps.
4 dissecting forceps.
6 pairs of scissors.

2 large and 2 small retractors.
8 towel clips.

4 Lane's tissue forceps.
2 intestinal clamps.

An anaesthesia apparatus, and

An instrument steriliser.

188 MEDICAL HISTORY OF THE WAR

be provided with the necessary equipment from the special
reserve sets of outfits held at Boulogne and sent to Frevent.

Each corps of the Third Army was ordered to send from
field ambulances parties composed of 3 medical officers,

3 N.C.Os. and 24 men to the various casualty clearing stations ;

4 parties from the XVI I th Corps, 3 from the VI th Corps,
2 from the IVth Corps, 2 from the Illrd Corps, and 2 from
the Vllth Corps.

The general arrangements then made for the clearing of the
wounded and sick from the different corps are shown on the
diagram.

Wounded from the Tank Corps were to be evacuated
according to the arrangements of the division in whose area
the tanks were operating. From the Cavalry Corps they
were to be evacuated to the nearest casualty clearing station.
Indians were, however, to go to the Lucknow C.C.S., but
serious cases were to be sent to the nearest casualty clearing
station.

Each corps had one motor ambulance convoy allotted to
it. These were supplemented as required by fifty motor
ambulance cars, which were sent to Frevent from the First
Army, and placed at the disposal of the D.M.S., Third Army.

Seventy buses or charabancs were allotted for evacuation
of the sitting cases, 30 to the Illrd Corps and 30 to the IVth
Corps, with 10 in reserve.

Reserves of stretchers and blankets were kept in dumps at
Ytres (750 stretchers), Tincourt (500 stretchers), Grevillers
(1,000 stretchers and 3,000 blankets). They were to be used
for exchange of stretchers and blankets brought back from
the front. They were placed in charge respectively of Nos. 45,
5, and 3 Casualty Clearing Stations.

Up to the 18th November no urgent wires for extra stores
were allowed to be sent to the Base Depots of Medical Stores,
but on that date four lorry loads of stores arrived from No. 13
Base Depot of Medical Stores, Abbeville, and 30,000 bandages
and other equipment from the First Army.

Entraining medical officers were allotted to each ambulance
train loading station, namely, at Tincourt, Grevillers, Ytres,
Doullens, Villers - Bretonneux, Achiet - le - Grand, Edgehill,
Boisleux-au-Mont, and Peronne-la-Chapellette. At those
stations where there were two casualty clearing stations, an
assistant entraining officer was also allotted. These officers
were obtained from the casualty clearing stations or stationary
hospitals in the locality.

Scheme of Evacuation op Sick and Wounded from 1V&TH Corps
during The Battle ofCambrai , November 1917.

IV CORPS

Right S&ctor.

'CCS
G&EWLLERS.

fS6

:.cs.

/&GEH/LL.

Ill CORPS

> T . H Div. 20™ Ptv. 12™ P>v.

T&cW ^'• c - s | ▼ cc " s -

■' Lying cases. «-■ — ■— Wauunq Wounded

—••• SicJr.

NOTE. The above shows & corps method, of evacuation in
the m Corps and a divisional method in the Tj? Corps.

Chape u-£t~te.

is zec-ec.5060 ' i<u . fsoo n Z3.

MEDJCAL SITUATION IN THE IV & III CORPS DURING THE BATTLE OF CAMBRAI NOVEMBER 1917.

+ Reg A id Post. QAcfy.Dr. Sta. A W/kng. Wnd. Sta. E3 Main 0n Sta § Cas. CI Sta. -*-*•*- Decauvi'lle. Railway, - t-m 1 1 1 h Other Railways.
— Original British Front Line, Nov. 19*$ m-m. British Line,Noven?ber2l s . t -•-• British Line, Nov. 29*." •••••Final Br. Line. Dec?*/ 1

'-ww The Hindenburg Line. ///////////////, Qorps Area Boundaries .
NOTE. The shaded conventional signs represent positions occupied by Advanced and Main Dressing Stations during the
British advance. The Advanced Dressing Station at Villers Guislain was captured by the enemy during the German advance-

'Z/0.24S4? 5060. I4J. 1500,8.23.

Malby&Sons.Lith.

THE CAMBRAI OPERATIONS IN 1917 189

The usual policy of filling the casualty clearing stations in
rotation by 150 stretcher cases at a time was followed, except
where both lying and sitting cases were received, and then
200 were taken in at a time.

Medical Arrangements in Corps and Divisions.

The same secrecy had to be maintained in the organization
of the corps and divisional medical services. The preparation
and expansion of advanced dressing stations, walking wounded
collecting posts and so on were prohibited until the evening
before the battle. Divisions which were to take part in the
attack occupied their sectors only two days before it was
launched. But divisions holding the line until then prepared
accommodation and gradually accumulated as much additional
stores as possible, while the medical officers from the attacking
divisions were sent up to reconnoitre the area.

The Illrd Corps. — The Illrd Corps headquarters with
Colonel S. Macdonald as D.D.M.S., were at Templeux-la-Fosse.
On the 9th November the divisions allotted to the corps were
the 12th on the right, the 20th in the centre, and the 6th on
the left, with the 29th in reserve ready to pass through the
20th and push on and capture the Canal crossings at Marcoing
and Masnieres. These divisions were resting in the back area
and were only brought up during the three days preceding
the offensive. The 20th Division alone was in the line before
then. It had a divisional main dressing station on the Fins-
Nurlu road, and advanced dressing stations at Gouzeaucourt
and Villers Guislain, with a corps rest station at Moislains,
and was evacuating its sick and wounded to Ytres and
Tincourt.

The main dressing station was hutted, well equipped with
electric light, operating theatre, and gas treatment centre,
and could be made to accommodate 500.

The advanced dressing station at Gouzeaucourt was in
cellars with ample accommodation and well protected. That
at Villers Guislain was small.

Immediately before the advance, the 20th Division retained
Gouzeaucourt as its advanced dressing station, Villers Guislain
was handed over to the 12th Division, and the 6th Division
had to form a new advanced dressing station, north of
Gouzeaucourt.

A corps walking wounded station was also prepared alongside
the corps main dressing station.

190 MEDICAL HISTORY OF THE WAR

Additional equipment and stores consisting of 2,000 stretchers,
6,000 blankets, and 48 marquees were obtained.

No. 21 Motor Ambulance Convoy came under the corps
administration and was at Peronne ; but was moved to
Moislains before the attack.

The whole of the medical arrangements were complete by
the 19th, all posts being amply stocked with additional equip-
ment and dressings.

It was decided that the lying down wounded were to be
evacuated direct from the advanced dressing stations to the
casualty clearing stations, as the position of the casualty
clearing stations at Ytres favoured this. It was anticipated,
however, that if walking cases were sent direct to casualty
clearing stations, the latter might become rapidly congested
with them, and it was consequently arranged to send the
walking cases in the first instance to the corps walking wounded
collecting station before transferring them to the casualty
clearing stations.

The corps main dressing station was kept as a reserve in
case the casualty clearing stations became congested.

Some of the A.Ds.M.S. of divisions were not entirely in
favour of this method of direct evacuation from the advanced
dressing stations, mainly on account of the difficulty in
obtaining accurate returns for the divisional headquarters.
The officers commanding the casualty clearing stations were
also doubtful whether it would be possible to prepare returns
and give anti-tetanic serum to cases evacuated to them direct.
It was consequently decided that the field medical cards
were to be made out at the advanced dressing stations and
the anti-tetanic serum given on arrival of wounded at the
casualty clearing stations. Events, however, proved that it
would have been simpler for the anti-tetanic serum to have
been administered at the advanced dressing stations and the
field medical cards made out at the casualty clearing stations,
instead of the reverse process.

The necessity of maintaining secrecy made it impossible to
enlarge the casualty clearing station centres previous to the
battle, and the fact that the casualty clearing stations were in
groups of two instead of three added to the difficulties of
direct evacuation to them from the advanced dressing stations.

The Illrd Corps had at its disposal four covered ambulance
wagons on the Decauville railway fitted with necessary
equipment and heated by oil stoves. The railway system
connected two of the three advanced dressing stations with

THE CAMBRAI OPERATIONS IN 1917 191

the corps main dressing station, the corps walking wounded
station, and all the casualty clearing stations.

Decauville ambulance trains and motor ambulance cars
were available for bringing back the stretcher cases. For the
walking wounded there were the buses and returning empty
Decauville trains.

Two Decauville ambulance trains, each with two ambulance
wagons and one ordinary wagon, were formed, the ordinary
wagon being for the conveyance of walking cases from the
advanced dressing stations to Fins. From Fins horsed
ambulance wagons and motor buses were assembled for
bringing the walking wounded to the walking wounded
collecting station. From there they were transferred to the
casualty clearing stations at Tincourt by an improvised
Decauville train, consisting of six trucks covered with
tarpaulins, and by buses or lorries.

The time taken by the Decauville ambulance trains proved
to be longer than was anticipated ; for the circular trip
from the corps walking wounded collecting station to Tincourt
took five and a half hours instead of four hours.

Divisional motor ambulance cars were pooled to form an
additional convoy.

Sick were sent to the corps walking wounded collecting
station and transferred from there to the corps rest station at
Moislains by buses or ambulance cars, with the exception of
serious cases which went to the casualty clearing stations.
They were thence, if necessary, transferred to No. 56 CCS.
at Edgehill.

Buses and lorries worked well during the day of the 20th.
The former were, however, withdrawn at 4 p.m. on that day,
but a number of lorries was obtained in their place, together
with twenty-five motor ambulance cars from the D.M.S. of
the Army.

The IV ih Corps. — In the IVth Corps the divisions on the
northern sector were not likely to be heavily engaged and the
arrangements made during the quiet periods of trench warfare
were considered sufficient for all practical purposes as regards
evacuation from that area. On the southern sector, however,
it was anticipated that there would be great difficulties in
connexion with evacuation as there was practically only one
road from Flesquieres-Ribecourt to Metz-en-Couture and
Ytres. This line of evacuation for the 51st and 62nd Divisions
was likely to be seriously blocked by traffic immediately after
the attack.

192 MEDICAL HISTORY OF THE WAR

A corps main dressing station was established by the 51st
Division at Ruyaulcourt, and an advanced dressing station
on the south of Havrincourt Wood, north of Metz-en-Couture.
From this advanced dressing station stretcher cases were to
be evacuated direct by the motor ambulance cars to the
casualty clearing stations at Ytres. It was also intended to
make use of the Decauville railway system, if possible, by the
services of three trains running constantly from the advanced
dressing stations to Ytres. A special siding had been prepared
at the advanced dressing station for the purpose. The
general intention was, as in the Illrd Corps, not to use the
corps main dressing station unless necessary, but to bring
patients direct from the advanced dressing stations to the
casualty clearing stations. The main dressing station was,
however, to be kept ready for wounded, whom it might be
necessary to evacuate by road, from the left sector.

A corps walking wounded collecting station was established
by the 62nd Division at the south-west corner of Havrincourt
Wood. Wounded were to be evacuated from that point to
field ambulances at Bus by the Decauville railway. They
were to be taken from Bus in buses to the casualty clearing
stations at Grevillers.

The 36th Division on the left of the 62nd Division had one
brigade in the line on the Canal du Nord, with two brigades
in reserve and with the 56th Division on its left. Advanced
dressing stations were at Hermies for the 36th, and at Doignies
for the 56th Division, with main dressing stations at
Lebucquiere and Beugny.

Dumps of 1,000 stretchers, 3,000 blankets, 20 small marquees,
and 20 oil stoves were formed at Ruyaulcourt and Bus, and
there were in the corps area on the 18th November, exclusive
of the mobilization equipment of the medical units, as many
as 16,548 blankets, 3,828 stretchers, and 56 small marquees.
The erection of marquees for the walking wounded posts
was only permitted under cover of darkness on the night of the
19th/20th.

Thirty buses were allotted to the D.D.M.S. IVth Corps and
assembled at Bus on the morning of the 20th November.
No. 27 M.A.C. was attached to the corps, and the general
supervision of evacuation by means of the field ambulance cars
and motor ambulance convoy cars from the advanced dressing
stations was to be under the officer commanding the convoy.

There were two light railway companies with the IVth
Corps, No. 9 with its headquarters at Ytres, and No. 4 with

THE CAMBRAI OPERATIONS IN 1917 193

Its headquarters at Bapaume. On No. 9 light railway com-
pany's system eight trucks were made available for wounded,
each carrying twelve lying cases. A train composed of two
or three of these trucks was normally kept at Ruyaulcourt.
On No. 4 light railway company's system there were four
covered ambulance trucks with capacity for twelve lying down
in each, normally kept at Lebucquiere or Beugny.

Walking cases were sent down on the returning empty trains.

No. 9 railway system had sidings running into the casualty
clearing stations at Ytres, and No. 4 had detraining posts a
little to the south-west of Bapaume, where the wounded were
unloaded and taken by car to Grevillers, three motor ambulance
cars with two medical officers and a stretcher party being
stationed there for the purpose.

The Vlth Corps. — In the Vlth Corps, which was on the
right of the IVth Corps during the battle, similar arrangements
had been made with regard to the use of the light railway.
Three different patterns of ambulance trucks had been con-
structed, one was an open truck for trench tramways carrying
three stretchers, another type was a light railway truck, with
framework and cover, taking twelve stretcher cases, and the
third type was a truck heated by a coke stove and fitted with
spring supports for twelve stretchers. It was covered with
waterproof canvas, and could be loaded by four loading parties
in forty seconds. It was comfortable and warm. It was pro-
posed to supply twelve of these converted trucks for use
with the Vlth Corps.

Light railway sidings were prepared at No. 45 and No. 49
C.C.Ss. at Achiet-le-Grand, the lines running up to the main
dressing station at Favreuil, north of Bapaume.

The Cavalry Corps. — The arrangement in the Cavalry Corps
for the attack on the 20th November was for the wounded to
be evacuated through the regimental aid posts and advanced
dressing stations of the Illrd and IVth Corps. Clerks were
to be sent to the walking wounded collecting stations and to
the casualty clearing stations at Grevillers and Tincourt for
recording the admissions.

The Cavalry Corps headquarters were then at Villers
Carbonnel. Its advanced headquarters went to Fins at 6 a.m.,
on the 20th November.

The cavalry brigades were accompanied by the pack mounted
sections of cavalry field ambulances,* v/hich were parked at

* See Chapter IV.

194 MEDICAL HISTORY OF THE WAR

Fins. The light sections were to go forward as far as possible
with dismounted stretcher bearers in the ambulance wagons.
They were to be followed by the heavy sections and the motor
ambulance cars. The heavy sections were to take over the
advanced dressing stations in the event of a successful advance,
and the cars were then to clear the wounded from them to the
most advanced infantry medical units. The duty of the pack
mounted sections was to supplement regimental aid posts and
collect wounded to places along the roads or into barns or
houses.

The D.M.S. of the Third Army was anxious to obtain inform-
ation regarding the suitability of tanks for bringing wounded
back from forward positions in cavalry action. A large store
tank supplemented by a trailer was reported to be suitable
for both stretcher and sitting cases ; but there is no record of
its having been used.

The Medical Services during the Battle.

The Illrd and IV ih Corps Medical Services. — During the
first phase of the battle, November 20th to 28th, the total
casualties received into the medical units were 17,293, of
whom 689 were officers, 15,038 other ranks, and 1,566 enemy
wounded. The system of evacuating the seriously wounded
direct to the casualty clearing stations at Ytres from the
advanced dressing stations of both the Illrd and IVth Corps
was not altogether a success. By the evening of the 20th
November Ytres was full of wounded and unable to take more.
Illrd Corps wounded were consequently switched off to
Tincourt, and the IVth Corps wounded to Grevillers. Owing to
the large numbers coming by ambulance car and by Decauville
trains some of the cars and trains were kept waiting for one or
two hours before they could be unloaded after arrival at Ytres
and consequently there was considerable delay in getting the
trains back to the advanced dressing stations. Parties of
stretcher bearers had consequently to be sent to Ytres to
expedite the unloading of the trains and cars.

When Ytres had thus to cease taking in casualties temporarily,
and ambulance cars with the wounded were sent on instead
to Tincourt, it became necessary to abandon the system of
direct evacuation to casualty clearing stations from advanced
dressing stations, on account of the long time the cars were
away on the journey. The normal system of evacuation was
then restored, namely, that of clearing the advanced dressing
stations by the field ambulance transport to a main dressing

THE CAMBRAI OPERATIONS IN 1917 195

station and clearing the latter by the motor ambulance convoy-
to the clearing stations.

This experience of a system of direct evacuation from
advanced dressing stations to casualty clearing stations is
important, as it emphasizes the fact that wounded as a whole
are not more advantageously dealt with in battle under such
a system than they are under the normal system. The rule,
however, that the comparatively small number requiring
urgent operations, such as men wounded in the abdomen,
should be sent direct to the nearest casualty clearing station
or advanced operating centre always held good ; but there
was no advantage in dealing with all the lying down wounded
in the same way. The general result was that wounded were
held up for long periods either at advanced dressing stations
pending the return of cars, or at casualty clearing stations
until the cars could be unloaded or until the congestion at the
casualty clearing stations could be relieved.

The difficulties which arose at Ytres in this respect did not
occur to the same extent at Tincourt. The number of wounded
from the southern sector was less. The Decauville train, however,
from the advanced dressing station at Villers Guislain did not
run well, owing to the tractor being unable to pull the wagons
up the hill between the station and Tincourt.

The night of the 20th/21st November was very dark and
wet, and some of the ambulance cars, which had to move
without lights, got ditched. The roads had been damaged
by shell fire and had become impassable in many places for
wheeled vehicles. This was more especially the case in the
IVth Corps area.

After the advance had been made to Marcoing, the Decauville
railway was linked up with the German Decauville system and
on the 21st ran up to Trescault, and subsequently to Ribecourt ;
but it was not possible to use it for the evacuation of seriously
wounded from the IVth Corps.

During the advance on the 20th and 21st November the
wounded of the IVth Corps had to be carried by hand from
the aid posts and advanced dressing stations, as the roads
leading to them had been destroyed by shell fire in many
places. The 62nd Division had opened an advanced dressing
station at Havrincourt in ruined buildings. The road between
that place and Trescault was in a very bad condition, and
the wounded had consequently to be taken back north of
Havrincourt Wood across the Canal du Nord by hand carriage
towards Hermies to the 36th Division advanced dressing station.

196 MEDICAL HISTORY OF THE WAR

On the 23rd November the wounded both of the 36th and
the 62nd Division had to be carried there by several relays,
for a distance of about four miles in some cases, owing to the
condition of the roads. An advanced dressing station was
then established at Graincourt between Bourlon Wood and
Flesquieres. The 51st Division had formed an advanced
dressing station at Flesquieres immediately after it had been
captured on the 21st November, and the advanced dressing
station at Graincourt was cleared to it.

On the 25th November ambulance cars were able to run
between Trescault and Ribecourt, although with considerable
difficulty owing to the condition of the road, but later in the
day a large number of cars were able to work between
Flesquieies and Ytres, via Ribecourt, Trescault, and Metz,
which was the main line of evacuation from the right sector
of the IVth Corps.

Wounded of the 36th Division on the left were evacuated
through Demicourt and Hermies to Lebucquiere, and thence
by cars and Decauville railway to Grevillers. The walking
wounded found their way to Ribecourt on foot and were taken
back on the Decauville railway trucks from there.

The work of clearing aid posts and dressing stations by
road was hampered not only by the damage done by shell
fire, but also by the roads being congested with traffic of all
kinds. Thus on the 20th November, when the 62nd Division
advanced on Havrincourt, the roads became packed with
guns and transport and it was impossible to use ambulance
transport on them till late in the afternoon. The only roads
suitable for transport were through Trescault to Havrincourt
and through Havrincourt High Woods to the north-east
corner of the wood. No motor transport could advance
beyond these points, and as already noted an alternative
route of evacuation was established north of Havrincourt to
the 36th Division advanced dressing station at Hermies.
By the 25th November, however, horsed ambulance wagons
could be employed between Graincourt advanced dressing
station and Flesquieres, and thence through Ribecourt or
Havrincourt.

The Illrd Corps divisions were more favourably placed
than those of the IVth Corps after the advance. On the 21st
November the 29th Division had gone through the 20th
Division and had opened advanced dressing stations at Marcoing
and Masnieres with a walking wounded collecting post at
La Vacquerie, half-way between Gouzeaucourt and Masnieres.

THE CAMBRAI OPERATIONS IN 1917 197

The 6th Division had moved its advanced dressing station
to Ribecourt with a collecting post at Villers Plouich. The
other divisions in the line, the 12th and 20th, had their advanced
dressing stations at Gonnelieu and Gouzeaucourt.

The Cavalry Medical Services. — The A.D.M.S. of the 5th
(Indian) Cavalry Division, a squadron of which had gone
through the gap in the enemy's line on the 20th November,
had assembled the pack mounted sections with their brigades,
while the light sections and all motor ambulance cars were
assembled at Villers Plouich ready to move to Rumilly and
establish an advanced dressing station there. The heavy
sections moved up to Fins from Bouchy near Tincourt during
the day.

The 1st Cavalry Division bearers and ambulance wagons
were brought up to Ribecourt ready to advance to Marcoing.
A cavalry field ambulance, the Lucknow, of the 4th (Indian)
Cavalry Division moved to Gouzeaucourt on the 22nd
November, with its pack mounted section at La Vacquerie.
The stretcher parties went forward to a relay post near Mar-
coing on the 21st November, and according to the diary of
the A.D.M.S., there was no difficulty in collecting the wounded
of the 5th Cavalry Division during the mounted operations
on that day.

The majority of the casualties were in the Canadian Cavalry
Brigade.

The Medical Services during the German Counter- Attack.

In the second phase of the battle, when the German attack
took place on the 30th November, the disadvantage of having
large immobile dumps of medical stores in advanced centres
and casualty clearing stations near the front line became
prominent. The medical units chiefly affected were those of
the Vlth Corps and the casualty clearing stations at Ytres.
The advanced dressing stations at Villers Guislain and
Gouzeaucourt fell into the hands of the enemy by 10 a.m., and
some of the personnel of No. 36 Field Ambulance at Villers
Guislain were captured. The personnel of the A.D.S. at
Gouzeaucourt got away together with the wounded before the
enenty entered the village, but a dump of stretchers, blankets,
marquees, and other stores was left behind. Gouzeaucourt
was, however, recaptured some hours later.

The Guards Division, which was brought down from the IVth
Corps to this front, formed advanced dressing stations between
Gouzeaucourt and Gouzeaucourt Wood, and on the road

198 MEDICAL HISTORY OF THE WAR

between Gouzeaucourt and Fins, where the 20th Division
also had its advanced dressing station. The 12th Division
opened a new advanced dressing station at Heudicourt. Seven
cars of No. 21 M.A.C. were ditched and had to be abandoned,
but the drivers canied the wounded away with them and
also brought back the carburetters. Three of the field am-
bulance cars were also put out of action. The main dressing
station on the Fins-Nurlu road was cleared and the divisional
rest station at Moislains was then prepared as a main dressing
station, after the sick had been removed from it.

The German attack, on the 30th November, resulted in
many losses in medical personnel of the Illrd Corps. One
officer was killed, three wounded, and six missing. Amongst
other ranks, 1 was killed, 21 were wounded, and 163 missing.

The left division of the Vllth Corps, the 55th, had its ad-
vanced dressing station at Epehy when the enemy attacked.
One officer and fourteen other ranks of the R.A.M.C. were
captured while working between it and the aid posts.

As might be expected, the casualty clearing stations at
Ytres were in imminent danger of capture. Orders were
consequently issued for the nursing sisters to be sent back by
ambulance cars, and the surgical teams distributed amongst
the casualty clearing stations at Tincourt and Grevillers. The
remainder of the personnel were to salve as much of the equip-
ment as possible and retire to places of safety, leaving sufficient
personnel in charge of the wounded until all could be got
away. It was considered unnecessary, however, to move the
casualty clearing stations, although they were frequently
shelled, and their position undoubtedly hazardous.

In the northern sector, between the canal and Bourlon
Wood, where the fighting was fiercest, 600 wounded had been
collected to Flesquieres and 350 to Havrincourt by 9-30 a.m.
on the 30th November, in addition to a large number of walking
wounded at Trescault. Every available car was sent up, but
the roads were blocked by traffic, and recent shelling had
rendered the road from Flesquieies to Havrincourt impassable
for ambulance cars. The railway lines from Ribecourt and
Trescault and from Havrincourt to Grevillers were of great
assistance. Many wounded were carried by hand from
the Bourlon Wood to a relay post north of Anneux and thence
by trolley line to a loading post between Anneux and Flesquieres,
where ambulance cars took them to the main dressing station.
From the west of Bourlon Wood the stretcher cases were
carried to a sugar factory on the Cambrai-Bapaume road, and

THE CAMBRAI OPERATIONS IN 1917 199

on to a car loading point on the road between Graincourt and
the canal, whence they were taken by car along the canal
road to Havrincourt advanced dressing station. Walking
wounded went back by the same road and on to Trescault.

Bourlon Wood was severely bombarded by gas shells on the
30th November, seven of the medical officers becoming casual-
ties. Owing to the thick wood and undergrowth it was difficult
to disperse the gas, even when a strong wind was blowing.
The dressing station at Flesquieres was heavily shelled in the
evening, three ambulance car drivers being killed, a wagon
orderly wounded, and several horses of the field ambulance
killed or wounded. The motor ambulance car service failed
on account of congestion of the roads with other traffic, but
two trains were run up on the broad-gauge railway from
Grevillers to Havrincourt and relieved the congestion at the
advanced dressing stations.

The relay post at the sugar factory on the Cambrai road
had good shelter and accommodation in cellars, but there
were no trenches from it backward. The position was isolated
and all approaches to it constantly shelled, and it was doubtful
whether the good accommodation and comparative safety
in the cellars were not more than counter-balanced by the
risk to bearers and the necessity of keeping the wounded for a
considerable time before they could be got away.

The cavalry divisions during the enemy attack were
dismounted and occupied sectors of the Vllth and Illrd
Corps front.

The Casualties.

The number of wounded admitted to medical units daily
during the battle and evacuated to the base is shown in the
table on the next page.

The greatest number of trains required for evacuation on
any one day was eleven, on December 1st. On November 20th,
eight were used, and on November 21st, 22nd, and 30th, seven.
On December 2nd there were nine trains.

Including sick, the total number evacuated up to December
4th was 35,597, of whom 16, 939 were lying, 17,163 sitting, and
1,495 German sick and wounded.

10134

200

MEDICAL HISTORY OF THE WAR

Number of Wounded admitted to Field Ambulances and evacuated

to the Base.

Woundec

admitted

evacuated

Date.

Total.

Other

Ger-

Other

Ger-

Officers.

ranks.

mans.

Officers.

ranks.

mans.

Nov. 20

153

2,838

222

3,213

1,179

1,316

119

2,623

690

3,432

139

3,253

605

3,997

1,467

416

1,946

1,604

330

2,014

1,039

1,123

748

867

107

2,275

2,444

1,906

2,075

1,290

1,361

897

993

1,139

1,216

1,309

1,413

1,089

1,205

305

326

1,288

—

1,347

1,647

1,767

715

—

752

299

381

1,916

—

2,003

1,590

1,671

Dec. 1

246

4,438

4,733

201

3,603

3,817

156

3,731

3,927

123

3,478

521

4,122

1,074

1,138

1,523

1,617

1,444

1,520

938

1,016

704

734

767

809

741

796

808

867

Totals . .

1,423

29,811

1,656

32,890

1,192

25,854

2,022

29,068

CHAPTER XII.

THE GERMAN OFFENSIVE IN 1918.

THE numerical superiority of the German forces on the
Western front, caused by the events in Russia, by the
transfer of British divisions to Italy, and by the reduction
of British divisions from 13 to 10 battalions, made a defensive
policy along the whole line held by the Allies in France and
Belgium imperative at the close of 1917.

When the XlVth and Xlth Corps, with the 23rd, 41st, 7th,
48th and 5th Divisions, were transferred to Italy between the
9th November and 1st December of that year, several
medical units were sent from France to Italy at the same
time. The divisions were accompanied by their field
ambulances and sanitary sections. Three sanitary sections
preceded them for work at the base and on the lines of com-
munication. Two motor ambulance convoys, No. 36 and
No. 26 ; five casualty clearing stations, No. 9 from Aveluy,
No. 38 from Bray, Nos. 24 and 39 from the Dunkirk area,
and No. 37 from Godewaersvelde ; Nos. 15 and 23 Mobile
Hygiene and Nos. 7 and 14 Mobile Bacteriological Laboratories ;
No. 11 General Hospital from Etaples* and No. 38 Stationary
Hospital, No. 32 Advanced Depot of Medical Stores, and
a Convalescent Depot were transferred from France to
Italy at this time. When two of the divisions, the 5th and
41st, returned to France early in March 1918, with their field
ambulances and sanitary sections, two of the casualty clearing
stations, No. 38 and No. 37, also came back, the former on
the 19th March and the latter on the 28th April.

The transfer of British troops to Italy also involved special
provision for the evacuation of their sick and wounded to
France. For this purpose No. 57 General Hospital, then at
Boulogne, was sent to Marseilles, and a large convalescent
depot, No. 16, was formed there. A second general hospital,
No. 81, came to Marseilles from Malta in January 1918.
Several ambulance trains, the number of which varied from

* This unit was occupied by the personnel of the Harvard Unit, U.S.A.,
but this personnel was transferred to No. 13 General Hospital, Boulogne,
and the personnel of the latter went to Italy as No. 11 General Hospital.

202 MEDICAL HISTORY OF THE WAR

time to time, were employed in evacuating sick and wounded
from Italy to the Marseilles base ; while Nos. 15, 18, 21 and
26 Ambulance Trains were transferred permanently to Italy
for use between the British front and base.

The fitting out of the British force to Italy thus diverted
some of the medical units and personnel of the R.A.M.C. from
work on the Western front at a time when personnel was
becoming more and more difficult to obtain.

Colonel F. R. Newland had been appointed D.D.M.S. of
the XlVth Corps in Italy, with Colonel S. L. Cummins as his
A.D.M.S. for the Italian lines of communication, on the 28th
October, but on the 23rd November the Second Army Head-
quarters moved to Italy and then Surg.-General R. Porter's
place, as already noted, was taken in France by the D.M.S.
of the Fourth Army, Surg.-General O'Keeffe. As Colonel
Newland, however, had been appointed D.M.S. of the British
Expeditionary Force in Italy with the rank of Surg.-General
by the War Office, Surg.-General Porter returned to France
on the 4th December, and pending early retirement on account
of age did not resume an administrative medical appointment
in the field.

In January 1918, the British front in France and Belgium
was extended southwards in a continuous line of one hundred
and twenty-five miles from Houthulst Forest in the north to
Barisis, some six miles south of La Fere, on the Oise. This
line was held from right to left by the Fifth Army from Barisis
to north of Gouzeaucourt ; by the Third Army from that
point to Gavrelle, north of the Scarpe ; by the First Army on
its left to Armentieres ; and by the Fourth Army* between
Armentieres and Houthulst Forest. Belgian troops were on
the British left. French troops had taken the place of the
latter on the coast sector.

Medical Arrangements previous to the German attack.

On the adoption of a defensive policy, the organization for
defence consisted of a lightly held " forward zone," about
one mile in depth, with a strongly wired " battle zone " some
four miles in depth to which the troops in the forward zone
were to retire in the event of attack. Behind the battle zone
was a third defensive line. As the point at which the enemy's

* The Fourth Army ceased to exist as such on the return of the Second
Army Headquarters staff from Italy, its Commander, General Sir H. Rawlinson
being appointed to the Supreme War Council in Paris.

It was re-designated the Second Army from the 13th March. 191 8.

GERMAN OFFENSIVE IN 1918 203

anticipated attack might be launched was unknown, although
the probability was that it would be against the Third and
Fifth Armies in the direction of the coast ports, the D.G.M.S.
was placed in the difficult position of determining how he
might best reinforce the medical services of one army by
transfer of units from another army in the event of sudden
attack. His chief anxiety was caused by the forward position
of many of the casualty clearing stations and the policy was
enunciated that, in defensive operations, two casualty clearing
stations should be open in a back area for one in a forward
area, as distinct from the policy in offensive operations of
having one casualty clearing station in a back area for two in
a forward area.

The Directors of Medical Services of the Fifth, Third, First
and Fourth Armies respectively, were Major-Generals B. M.
Skinner, Sir J. M. Irwin, H. N. Thompson and M. O'Keeffe.
The Director-General had obtained details of the arrangements
made by them and their Corps D.Ds.M.S. and Divisional
A.Ds.M.S., for the collection and evacuation of wounded in the
event of the British line being pushed back. From most of
the armies and formations maps showing positions to which
casualty clearing stations and other units in army areas would
move in the event of a retirement were submitted to the
D.G.M.S. early in March. The D.M.S., L. of C. also submitted
a statement of the action to be taken by him.*

Consequently, with a view to meeting the situation and
ensuring that adequate reinforcements for medical services
would be available for sending to any sector where a
determined offensive by the enemy might take place, the
following instructions were issued to the Ds.M S. of the Armies
and L. of C. by the D.G M.S. on the 6th March 1918:—

" 1. Casualty Clearing Stations.

(a) The Fourth Army, which has a surplus of casualty clearing
stations in proportion to divisions, will hold six of these casualty
clearing stations ready to move at a moment's notice with the
mobile equipment referred to in this office No. D.G. D/2279/71
dated 30th September 1916. (Copy attached. )t

* Surg. -General T. P. Woodhouse had reached the age limit for retirement
in December 1917, and his place as D.M.S., L. of C. was taken by Surg. -General
Can.

t The copy attached was as follows : —

" Recent moves of casualty clearing stations have shown that these units, so far as the
transport required to move them is concerned, have become extremely unwieldy. For example,
one casualty clearing station took 100 lorry loads and others 50 to 60 in order to move from
one place to another.

" You will please arrange, therefore, for each casualty clearing station to have ready now
a list of the articles which are necessary for carrying on emergent surgical work and providing
nursing facilities at main dressing stations or other suitable places in advance of its present
position, whenever the necessity of moving a casualty clearing station forward arises.

" This equipment should represent minimum requirements and should be limited to nine
lorry loads, to enable a casualty clearing station to open for work immediately without waiting
till the bulk of its material arrives."

204 MEDICAL HISTORY OF THE WAR

" These casualty clearing stations will be used : —

(i) For reinforcing the casualty clearing stations in army areas

whenever this becomes necessary,
(ii) For opening casualty clearing stations rapidly on sites further

back in the event of casualty cleaiing stations in forward areas

being temporarily out of action,
(iii) To open in any new area which may be taken over,
(iv) To form casualty clearing stations with any Force that may be

sent to opeiate elsewhere.

" It is not intended that casualty clearing stations selected for this
purpose should close down now, but they should be in a position to pack
up and load on lorries the equipment referred to in the above quoted
instruction with the least possible delay.

" All Ds.M.S. will notify to this office as early as possible the sites
selected, should move under (ii) be required.

(b) Casualty clearing stations of one Army will be made available
for wounded of the neighbouring Army, if required, under
arrangements to be made by Ds.M.S. concerned in direct com-
munication with one another.

"2. Motor Ambulance Convoys.

" Armies not actively engaged will be prepared to transfer one or
more ambulance convoys to another area when required to do so by
D.G.M.S.

" In the event of any breakdown in the running of ambulance trains,
reserve convoys are available for conveying wounded from the First and
Fourth Armies to hospitals in St. Omer, and from the Third and Fifth
Armies to hospitals in Amiens, Etaples and Abbeville.

" Ds.M.S. will report to D.G.M.S. whenever it becomes necessary to
carry out evacuation by road, notifying the casualty clearing station
which requires immediate relief, and the numbers in it waiting evacuation.

"3. Surgical Teams.

(a) From casualty clearing stations. — Each casualty clearing station
will be prepared to send, under Army arrangements, one
surgical team as rapidly as possible to reinforce casualty clearing
stations in the sectors attacked, whenever called upon to do so
by D.G.M.S.

" Each team will take with it the equipment noted in attached
Appendix, marked ' A,'* and biing it back on returning to its own unit.

(b) From Lines of Communication. — Teams have been earmarked to
be sent up to casualty clearing stations as required from the
L. of C. They will be sent to one or other of the stationary
hospitals in army areas or adjoining L. of C. area, and handed
over there to the Army concerned. The D.M.S. of the Army
will then be responsible for distributing them to casualty clearing
stations.

* Appendix " A *' — Equipment to be taken with a surgical team from a casualty clearing
station : —

1 Operating Table. 8 Towel Clips.

10 Sharp Scalpels. 4 Lane's Tissue Forceps.

18 Artery Forceps. 2 Intestinal Clamps.

4 Dissecting Forceps. Anaesthesia Apparatus.

6 Pairs Assorted Scissors. Instrument Sterilizer.

2 large, 2 small Retractors.

GERMAN OFFENSIVE IN 1918 205

" The following are the stationary hospitals most convenient for this
purpose : —

No. 42 for Fifth Army.
No. 6 for Third Army.
No. 12 for First Army.
No. 10 for Fourth Army.*
" But Ds.M.S. of Armies concerned will arrange direct with D.M.S.,
L. of C, any modifications of the above arrangements which they may
find more convenient, and notify to this office.

" It should be understood that the object of this arrangement is to
enable Ds.M.S. to take over at recognized centres, and distribute by
Army motor ambulance convoy teams coming from bases, such as Rouen
and Treport, with women drivers or others who do not know the positions
of casualty clearing stations.

" Ds.M.S. will be prepared to accommodate teams and drivers at the
stationary hospital should they arrive at an hour which prevents them
moving on at once to the casualty clearing stations.

"4. Special Surgical Sets.

" The special surgical sets referred to in this office No. D.G. L. 2279/95
dated 12th July 1917, will be sent to selected casualty clearing stations
when surgical teams are sent up from the L. of C. Arrangements are
being made to have the sets sent up if possible in advance of the teams,
but Ds.M.S. will understand that, as the sector of operations is not known
beforehand, it is possible that the teams may arrive simultaneously with,
or before, the surgical sets. Every endeavour will be made, however,
to get the sets up as early as possible.

"5. Other Personnel.

(a) The instruction that three medical officers and twenty-five men
are to be added to each casualty clearing station in an Army
area from field ambulances in that Army will hold good, but it is
hoped that shortly this addition to each casualty clearing station
will be made more or less permanent.

(b) Other Armies not actively engaged will be prepared to send as
many medical officers and other ranks as can be spared from
field ambulances to casualty clearing stations of other Armies,
when called upon to do so by D.G. M.S.

"6. Stretchers.

(a) In addition to the stretchers held on the mobilization scale of
field ambulances and on the expanded scale for casualty clearing
stations, there should be a reserve of stretchers which need not
exceed 2,000 in each corps, including the stretchers held by
field ambulances in rest stations, and 2,000 in Army Reserve,
including reserve of stretchers held in casualty clearing stations
or motor ambulance convoys.

(b) Should these require to be replenished at any time, Ds.M.S. of
Armies can obtain additional stretchers : —

(i) From ambulance trains, and

(ii) From a general reserve of stretchers held under D.G. M.S.
control at G.H.Q.
" This latter reserve will not be drawn upon except during an actual
offensive, and is intended as a reserve to replace any loss of stretchers
which may arise in connection with the operations or to provide stretchers
rapidly in the event of its being necessary to expand medical units in
new areas.

* These stationary hospitals were respectively at Amiens, Frevent, St. Pol and St. Omer.

206

MEDICAL HISTORY OF THE WAR

" 7. Blankets.

" Reserves of blankets will be held with the reserves of stretchers,
in the proportion of two blankets per stretcher in the Corps Reserve,
Army Reserve and G.H.Q. Reserve.

"8. Primary Suture of Wounds.

" The procedure in connexion with primary suture of wounds is noted
in Appendix marked ' B,'* and Ds.M.S. will take steps to see that all
medical officers concerned thoroughly understand what is required in
this respect."

The Defensive position of Casualty Clearing Stations.

The Fifth Army. — The Fifth Army, on taking over from the
French the line from Gouzeaucourt to the Oise, had its casualty
clearing stations established at the following places : —

Noyon

. No. 46..

14 miles from th
front lme.

Cugny

No. 41..

Ham

No. 61.. . ..

Tincourt

Nos. 5 and 55 . .

6i „

Roye

Nos. 50 and 53

Marchelepot . .

Nos. 32 and 34

Rozieres

No. 47

Peronne la Chapellett

e Lucknow CCS.

Maricourt Plateau .

No. 38 CCS. . .

(This casualty clearing station only arrived from Italy on the
eve of the German offensive.)

A stationary hospital, No. 41, was at Gailly on the Somme,
some 14 miles west of Peronne la Chapellette.

No. 42 Stationary Hospital, at Amiens, had come under the
administration of the D.M.S., L. of C

The Third Army. — By the beginning of March, the D.M.S.
of the Third Army was withdrawing his casualty clearing
stations from the two most forward positions at Ytres and
Boisl eux-au-Mont .

* Appendix " B." — Procedure in connection with Primary Suture of Wounds.

"1. It is understood that all concerned in the treatment of wounds at casualty clearing
stations and hospitals are now fully instructed in the principle of primary suture of wounds
of the soft parts.

"2. Primary suture will, however, only be resorted to when the patient can be retained in
the unit for seven days.

" 3. In the case of casualty clearing stations this is only possible in quiet times and when
large numbers of wounded are not anticipated.

" 4. When it is not possible to retain patients in casualty clearing stations for seven days
the wounds of the soft parts will be cleaned up and destroyed tissue excised. The patient will
then be evacuated with the wounds open with as little delay as possible.

" 5. Patients whose wounds have been dealt with in this manner, that is to say, whose wounds
have been prepared in casualty clearing stations for delayed primary suture in the L. of C.
hospitals will have " D.P.S." (i.e., Delayed Primary Suture), clearly marked in block letters
in the space under (3) of the Diary of Transference on the Field Medical Card envelope (Army
Form W. 31 18. a.).

" 6. Wounded arriving at Base Hospitals so marked will be attended to with the least possible
delay, and, if there are no indications to the contrary, delayed primary suture carried out."

SKETCH MAP SHOWING THE RELATIVE POSITIO N S OF CASUALTY CLEARING

STATIONS AND HOSPITALS TO THE FRONT LINE D URIN G THE PERIOD OF DEFENCE

PREVIOUS TO THE GERMAN OFFENSIVE IN 1918.

GERMAN OFFENSIVE IN 1918 207

A site for Nos. 21 and 48 from Ytres had been selected near
Beaulencourt three miles south of Bapaume and some ten
miles from the front line. Nos. 43 and 20 from Boisleux-au-
Mont were being withdrawn to Le Bac du Sud on the Arras-
Doullens road between thirteen and fourteen miles from the
front ; one of the two casualty clearing stations, however,
was being kept open at Ytres and Boisleux-au-Mont until the
other was ready to receive patients on the new site.

The casualty clearing stations at Agnez-les-Duisans, Achiet-
le-Grand, Grevillers and Edgehill were left in position, but
the two at Achiet-le-Grand, Nos. 45 and 49, were to withdraw
to Grevillers in case of necessity, as, owing to their proximity
to an important railway junction, they were likely to come
under heavy shell fire. An alternative ambulance train
siding for patients from the casualty clearing stations at
Achiet-le-Grand was also being prepared at Miraumont, in
the event of ambulance trains being prevented by hostile
fire from coming up to Achiet-le-Grand. All these positions
were within ten or twelve miles of the front line, except Edgehill,
which was some twenty-three miles back. Schemes, however,
were drawn up for their retirement. The D.M.S. of the Third
Army regarded his first line of casualty clearing stations as
those at Beaulencourt, Grevillers and Achiet-le-Grand, his
second line as Edgehill, to which the casualty clearing stations
at Beaulencourt would retire, and Aveluy, for those withdrawn
from Achiet-le-Grand and Grevillers. Le Bac du Sud and
Agnez-les-Duisans were also regarded as second line positions,
although somewhat far forward. His third line consisted
of the stationary hospitals at Doullens, Frevent and St. Pol.
Although, therefore, in the distribution of casualty clearing
stations too many were in a forward area, complete schemes
were ready for their withdrawal in the event of a retirement.

The D.M.S. of the Third Army appears to have had some
anxiety regarding the group of casualty clearing stations at
Agnez-les-Duisans as a second line group, and each of the
three casualty clearing stations there had been instructed to
prepare in minute detail measures for falling back rapidly
either on Aubigny or St. Pol. Indeed all the casualty clearing
stations of the Third Army had prepared detailed schemes
for withdrawal to the third line at Doullens, Frevent or St. Pol.

The First Army. — The First Army casualty clearing stations
in March 1918, were at Ruitz, Nos. 1 and 4 Canadian, Nos. 6
and 15 ; Chocques, No. 1 ; Bruay, No. 22 ; Lapugnoy, No. 18 ;
Lozinghem, No. 23 ; Merville, Nos. 51 and 54 ; St. Aubin,

208 MEDICAL HISTORY OF THE WAR

Nos. 30 and 57 ; Lillers, No. 58 ; Haverskerque, No. 33 ;
Aubigny, No. 42. Those at St. Aubin were clearly too far
forward and the D.M.S. of the Army was instructed by the
D.G.M.S. to move them back. Consequently No. 57 had
already been brought back to Aubigny by the 18th March.

The Fourth Army. — Those of the Fourth Army were at
Oultersteene, No. 2, No. 1 Australian and No. 2 Australian,
the last having been brought back from Trois Arbres on the
15th March ; Dozinghem, No. 4 ; Remy Siding, Nos. 10, 17,
2 Canadian and 3 Canadian ; Godewaersvelde, No. 11 ;
Arneke, No. 13 ; Ebblinghem, No. 15 ; Rousbrugge, No. 36
from the Dunkirk area ; Nine Elms, No. 44 and No. 3
Australian; Bandaghem, Nos. 62 and 63.

The sketch map shows the relative positions of the
casualty clearing stations to the front line. The interrupted
line on the map indicates the limit of what the D.G.M.S.
considered to be the forward zone beyond which casualty
clearing stations should not be placed in a situation of defence
in view of the possibility of the line being forced back.

Divisional and corps medical arrangements were generally
the same as during the periods of trench warfare and the
battles of 1917, but with elaborate arrangements for corps
rest stations and scabies centres in back areas and for treating
gas casualties in front areas.

Schemes had been prepared for advanced and main dressing
stations to fall back to new positions in the event of a retirement,
the general arrangement being for the advanced dressing
stations to fall back on main dressing station positions and
the latter on casualty clearing station positions, but, as will
be seen, in the case of the Fifth Army the policy was to
eliminate main dressing stations and evacuate direct from
advanced dressing stations to casualty clearing stations.

Outline of the operations.

This then was the medical situation prior to the German
offensive. The attack was opened on the 21st March, shortly
before 5 a.m., by " a bombardment of great intensity, with
gas and high explosive shells from all natures of artillery and
trench mortars." * It was launched against the whole of the
Third and Fifth Army fronts, " while road centres and railways
as far back as St. Pol were engaged by high velocity guns."
Other fronts were also subjected to bombardments and to gas

* Sir D. Haig's despatches, p. 186.

GERMAN OFFENSIVE IN 1918

209

attacks, but the chief offensive was confined to the front
between the Sensee, south of Arras, and the Oise.

The Fifth Army front on the British right was held by the
Illrd, XVIIIth, XlXth and Vllth Corps, with the Cavalry
Corps in reserve. Their respective D.Ds.M.S. were Colonels
V. Prynne, H. I. Pocock, E. W. Slayter

S. Macdonald, H.

and F. J. Morgan.

The divisions in

to left as follows

line with their A.Ds.M.S., were from right

Illrd
Corps

'58th Division Colonel J. W. H. Houghton,

A.D.M.S.

18th „ Colonel J. Poe, A.D.M.S.

14th ,, Colonel J. H. Campbell,

A.D.M.S.

XVIIIth
Corps

'36th Division
30th

61st

Colonel
Colonel

H.
J-

Colonel C.

S. Roch, A.D.M.S.
D. Alexander,

A.D.M.S.
H. Howkins,

A.D.M.S.

'24th Division Colonel F. R. Buswell,
XlXth J A.D.M.S.

Corps | 66th „ Colonel J. Mackinnon,

A.D.M.S.

Vllth
Corps

16th Division Colonel A. W. N. Bowen,

A.D.M.S.

21st „ Colonel C. W. Profeit,

A.D.M.S.
9th „ Colonel O. W. A. Eisner,

A.D.M.S.

In reserve were the 2nd, 3rd and 1st Cavalry Divisions,
with Colonels A. H. Safford, J. Powell and T. C. Mackenzie as
their A.Ds.M.S., at Guiscard, Athies and Peronne respectively ;
the 20th Division, Colonel B. F. Wingate, A.D.M.S. ; 50th
Division, Colonel A. Milne-Thompson, A.D.M.S. ; and the
39th Division, Colonel G. W. Brazier-Creagh, A.D.M.S.

The Third Army front was held by the Vth, IVth, Vlth and
XVIIth Corps, whose respective D.Ds.M.S. were Colonels
O'Callaghan, Pollock, Hinge and Bray.

Ten divisions in line on the Third Army front were the
47th, 63rd and 17th of the Vth Corps, the 51st and 6th of the

210 MEDICAL HISTORY OF THE WAR

IVth Corps, the 59th, 34th and 3rd of the Vlth Corps, and the
15th and 4th of the XVII th Corps. The 56th Division of the
XHIth Corps of the First Army was on the left of the 4th
Division ; and the 2nd, 19th, 25th and Guards Divisions were
in close reserve, with the 41st Division from Itafy and the
40th Division further back, and the 31st Division marching south
to the Third Army area from Frevillers in the XHIth Corps area.

Between the 21st and 23rd March, the Fifth Army front had
retired from its battle zone, after severe fighting, to a line
running from the Oise at Viry-Noreuil northwards to the
Somme Canal, west of Ham, then along the Canal to west of
Peronne and thence north of the Somme to the east of Sailly-
Sallisel.

The Third Army had retired at the same time to a line
running from the Fifth Army left to the east of Ytres and
thence roughly in a north-easterly direction, west of St. Leger,
to Boyelles, from which point it ran east of Arras to Fampoux
on the Scarpe.

In the earliest phases of the attack, therefore, the positions
of the casualty clearing stations at Cugny, Ham, Peronne la
Chapellette, Ytres and Boisleux-au-Mont, were either in the
enemy's hands or in the front line of battle.

On the 24th March, the Third Army line retired to a new
line running from Boyelles southwards, west of Bapaume
through Longueval to the Somme between Curlu and Clery.
The Fifth Army line followed the Somme from there to the
east of Marchelepot, but from that point southwards the line
ran considerably west of the Somme, which the enemy had
crossed at Ham and elsewhere, to the Oise between Chauny
and Abbecourt. The part of the line from the Oise to a point
about five miles south of Nesle was taken over by the French
troops at this time, and the Illrd Corps, which occupied the
sector previously, came under the command of the French.

On the 25th March, the line of the Somme south of Peronne
was abandoned, and the casualty clearing station positions
at Noyon and Marchelepot, and at Peronne la Chapellette
fell into the hands of the enemy. North of the Somme the
enemy pushed a salient into the Third Army line along the
Ancre Valley from Achiet-le-Grand to Beaucourt-sur-Ancre
arid thence through Thiepval, Contalmaison and Montauban
to Curlu on the Somme. Consequently Achiet-le-Grand and
Grevillers no longer existed as casualty clearing station positions.

The retirement was continued on the 26th March by the
Third Army, which straightened its line to positions along
the Ancre to Albert and Dernancourt and thence south to

GERMAN OFFENSIVE IN 1918 211

the Somme opposite Chipilly, while the Fifth Army continued
to hold the south bank of the Somme to a point opposite Bray.
Its line from there ran south through Rozieres to some four
miles west of Roye. The French line ran thence south-east
to the Oise west of Noyon. By this retirement all the original
casualty clearing station positions of the Third and Fifth
Armies were in the front line or in the enemy's hands, with
the exception of Agnez-les-Duisans.

From the 26th March until the 5th April, when the German
offensive against the Third and Fifth Armies ceased, the
Third Army line remained practically unchanged, except that
it was withdrawn west of Albert and Dernancourt and ran
to the Somme at Sailly-le-Sec, the Vllth Corps operating
north of the Somme being transferred to it from the Fifth
Army. The Fifth Army was compelled to withdraw on the
Somme to the point at which the Third Army line had stabilized
on the north bank, but its line formed a salient from there to
Rozieres and Arvillers, where it joined the French line, now
withdrawn to the west of Montdidier. The line from there
ran eastwards to the south bank of the Oise as far as the
original position south of La Fere.

On the 28th March the Rozieres salient was abandoned
and the line of the Fifth Army then ran from Hamel through
Marcelcave and Ignacourt to Mezieres, whence it was continued
by the French to the line of the Avre.

On the 29th and 31st March, the British line south of the
Somme was shortened, and did not extend farther south than
Hangard on the Luce. The French line was then withdrawn
to the west of the Avre from Moreuil and Morisel through
Grisvesnes to Ayencourt. Finally, by the 5th April, the British
line south of the Somme was brought somewhat farther back
to the west of Hamel and east of Villers Bretonneux, joining
the French line at Hangard.

From the afternoon of the 28th March the Fifth Army
between the Somme and the Luce was taken over by General
Sir H. Rawlinson, a reserve army under General Gough
being formed for the construction of a new line of defences
behind the armies engaged. On the 2nd April the Fifth Army
was re-formed as the Fourth Army, Major-General B. M.
Skinner carrying on the duties of D.M.S., until the 8th April,
when Major-General O'Keeffe rejoined it from the Second
Army as D.M.S. Major-General Guise Moores then succeeded
Major-General O'Keeffe as D.M.S. of the Second Army.

The medical situation during the offensive against the
British is recorded in the following chapters.

CHAPTER XIII.

THE GERMAN OFFENSIVE AGAINST THE FIFTH ARMY IN 1918.

IN the preliminary arrangements for the defence of the Fifth
Army front, the possibility of the line being driven back
beyond the sites of the casualty clearing stations does not
appear to have been fully realized. In fact the D.M.S. displayed
a tendency to prepare as much for an advance as for a retreat.
He was apparently reluctant to abandon the extensive surgical
work which had been practised so successfully by his casualty
clearing stations in the battles of Ypres in 1917. Obviously,
however, such work would be impossible during a retreat,
at any rate in forward C.C.Ss., as was indicated in the D.G.M.S.
instructions of 6th March 1918.

On the 26th February the D.M.S. of the Fifth Army had
issued a series of instructions for medical arrangements in
the event of an advance or a retirement, and had asked the
D.A. & Q.M.G. of the Army if he could be provided in an
emergency with one hundred lorries to move a casualty clearing
station from Tincourt in one day, thus showing that there
was no intention to move from this dangerously advanced
position except at the last moment, and at a time when a
move of the nature contemplated would be fraught with
difficulty. Again, on the 28th February, he ordered the
casualty clearing stations at Tincourt to indent for more
hospital marquees in order to increase their accommodation,
thus adding to the bulk of equipment that would require
removal.

On the 2nd March, at a conference of Ds.M.S. of Armies
held at the D.G.M.S. office by the D.D.G., the D.M.S. of the
Fifth Army was warned that his casualty clearing stations
might be lost in the event of a sudden attack, but he then
expressed a hope that he would get them away complete in
good time, as he had asked for trains to be ready to remove
the units as soon as danger was foreseen. Here, again, the
mistake was being made of waiting until the actual danger
occurred to bring back casualty clearing stations in dangerously
forward positions, and then arranging not for a mobile section
to be moved, such as would require only eight or nine lorries
and would be capable of being got ready for work immediately

MOVEMENT OF CASUALTY CLE ARING STATIONS OF FIFT H_ARMY DURIN GjgR MAN OFFENSIVE, ggRING OF 1918.

GERMAN OFFENSIVE AGAINST FIFTH ARMY 213

in a new site, but for the whole bulky unit to be moved back
at one time, requiring a complete train or a hundred or more
lorries, both uncertain transport during a sudden retirement.
Further, when No. 38 CCS. from Italy was being brought
into the Fifth Army area, the site suggested for it by the staff
of the Army on the 12th March was Bray, but to this the
D.M.S. objected as being too far back. It was consequently
sent instead to Maricourt Plateau.

As might have been expected such arrangements were
bound to lead to much loss of equipment, with resulting
inadequate arrangements in back areas, in the event of a
retreat ; and this was what actually happened. Fortunately,
however, all the wounded, and they numbered many thousands,
who were brought back to the casualty clearing stations,
were evacuated and the personnel also got away before the
units were captured by the enemy.

The Casualty Clearing Stations.

The functions and accommodation of the casualty clearing
stations of the Fifth Army as detailed by the D.M.S. of the
Army, before the German attack, are shown in the following
table.

Medical Units.

Area.

Accommo-
dation for
wounded.

Gailly.

No. 41 Stationary-
Hospital.

All sick from Proyart and Boves areas
north of Amiens road and from Bray
area.

Infections from Bray, Proyart and Boves
areas.

N. Y.D.N

Self-inflicted wounds

Ear, Throat and Nose special cases

> 1,000

Tincourt.
Nos.5&55C.CSs.

No. 5 CCS.
No. 55 CCS.

All battle casualties from Vllth and

XlXth Corps.
Acute and urgent medical cases (excluding

Infectious) from Vllth and XlXth

Corps areas.
Gassed cases of Vllth and XlXth

Corps.

> 2,000

La Chapelette. |

Lucknow CCS. . . j All Indians — sick and wounded

600

214

MEDICAL HISTORY OF THE WAR

Medical Units.

Area.

Accommo-
dation for
wounded.

Marchelepot.

Nos. 32 & 34 C.C.Ss.

No. 32 CCS

No. 34 CCS. . .

All sick from Training Area, north of
Warvillers — Freniches line, and sitting
sick from XlXth and Vllth Corps
front areas.

Dysentery and Dysenteric Diarrhoea

Eye Centre . . . . . .

Dental Centre

Infectious from areas east of Bray and
Proyart areas and south of Proyart
area.

Injuries to Skull from front as far south
as Holnon.

► 2,000

Ham.

No. 61 CCS. . .

All battle casualties and sick from XVIIIth
Corps north of St. Quentin-Somme
Canals and from Ercheu area, east of
Somme-Noyon Canal.

1,000

Cugny.

No. 41 CCS. . .

All battle casualties and sick from XVIIIth
Corps south of St. Quentin Canal to
Tugny, and thence to Dury, Sommette,
Bronchy and Le Plessis inclusive,
and Illrd Corps north of line Ber-
lancourt - La Neuville - Liez - Vendeuil
inclusive.

Gassed cases from Illrd and XVIIIth
Corps.

► 1,000

Noyon.

No. 46 CCS. and
Advanced Op-
erating Centre
at Abbecourt.

All battle casualties and sick south of
Vendeuil-Liez-La Neuville-Berlancourt
and Southern boundary of Ercheu
area ; also from Guiscard and Noyon
areas.

Abdominal injuries from this area to
advanced operating centre, Abbecourt.

> 1,200

Roye.

Nos. 50 & 53 C.C.Ss.

All sick from Rollot, Montdidier, Training
Area south cf line Warvillers-Freniches
(inclusive), Roye-Solente and Ercheu
(west of Somme-Noyon Canal) areas.

2,000

Rozibres.

No. 47 CCS. . .

All sick from Proyart and Boves area
south of Amiens road.

1,000

GERMAN OFFENSIVE AGAINST FIFTH ARMY 215

Immediately after the German offensive was launched the
two casualty clearing stations at Tincourt were ordered by
the D.M.S. to close for admissions at 8 a.m. on the 21st March,
but only No. 5 was ordered to strike tents and pack equipment
at once and prepare to move. The officer commanding No. 55
C.C.S., however, decided to do so without waiting for orders,
and by noon all the patients, except one unfit to be moved,
were evacuated by ambulance train. The nursing sisters of
both units and the surgical teams of No. 5 were sent to work
in Nos. 32 and 34 C.C.Ss. at Marchelepot, the same afternoon,
while the surgical teams of No. 55 went to No. 61 CCS. at
Ham. The equipment of No. 5 was loaded on goods trains
during the evening and was taken to Rozieres, where it com-
menced to open the following morning. The equipment of
No. 55 was hurriedly loaded on a train during the night and
all but a small amount was saved and brought to Rozieres,
where the unit was established alongside No. 5. However,
before the camps were ready to receive wounded at Rozieres,
all work was stopped there on the 24th March. The personnel
of No. 5 was then ordered to proceed to No. 42 Stationary
Hospital, Amiens, on the 26th March, to Namps on the 27th,
and to Picquigny the same afternoon, where it opened in build-
ings, obtaining drugs, dressings and equipment by local
purchase. The surgical teams of No. 55 CCS. rejoined their
unit at Rozieres during the night of the 22nd/23rd, having
left Ham hurriedly on foot without their kits or operation-
room equipment. Some of the stores of the unit were loaded
on trucks on the evening of the 24th March, and on the
following day a site was selected at Hargicourt as an entraining
centre for wounded. The stores of No. 55 CCS. arrived
there at 5 p.m., and two hours afterwards wounded began to
arrive in large numbers from the Roye group of casualty
clearing stations. At 8 p.m. the nursing sisters also arrived
from Roye. The unit was now out of touch with the D.M.S.
and the commanding officer sent several of the nursing sisters
to No. 42 Stationary Hospital, Amiens. By 4 p.m., on the
26th March the remainder of the stores and personnel arrived
at Hargicourt from Rozieres, and ambulance trains came up
during the afternoon. At 1 a.m. of the 27th March orders
reached the unit from the D.M.S. to move to Namps. All
the wounded were cleared by 9 a.m. in ambulance trains and
the bulk of the stores were taken to Namps by lorries. During
its stay at Hargicourt, 1,352 sick and wounded were admitted
to No. 55 CCS. On its arrival at Namps it opened alongside

10134 R

216 MEDICAL HISTORY OF THE WAR

No. 41, which had already arrived there from Cugny. Orders
were given to it to pack up and be ready to move by 10 a.m.
on 30th March, but it remained parked at Namps till the
4th April, when it was moved to Longpre.

No. 61 CCS. was ordered out of Ham at 3 p.m. on the 22nd
March. All patients were evacuated by 1 a.m. on the 23rd
and the personnel proceeded to Rozieres, and assisted in the
work of No. 47 CCS. there. It was only by the personal
efforts of the D.A.D.R.T., who arrived for the purpose of
evacuating the railhead at Ham at 4 o'clock in the afternoon
of the 22nd March, that No. 6 Ambulance Train was brought
up and loaded with the assistance of fifty or sixty men of
No. 28 Area Employment Company. Owing to the line being
cut, it was not possible to bring the train to the ambulance
train siding, and the patients had to be carried to a point on
the line about a quarter of a mile farther back. The wounded
were eventually entrained and evacuated under enemy
artillery fire. The equipment and stores were abandoned.
On the 27th March the personnel was attached to No. 42
Stationary Hospital, Amiens, and on the following day went
to Namps and formed an entraining centre there. The
commanding officer Lieut. -Colonel C H. Turner, had been sent
to Villers Bretonneux and was in charge of an entraining centre
at the railway station there between the 23rd and 27th March ;
on rejoining his unit, he was put in charge of the entraining
centre at Namps.

Orders to close No. 41 CCS. at Cugny were received at
6.50 a.m. of the 21st March. All patients were to be evacuated
by ambulance train about 11 a.m., but the line was cut, and they
were consequently sent by car and lorry to No. 61 CCS. at Ham,
to which also the nursing sisters and surgical teams were sent
by orders of the D.M.S. At 5.45 p.m. orders to move to Roye
arrived. Lorries were kept busy removing stores to Roye all
night, but at 10.45 a.m., the enemy being within three miles of
the unit, the personnel were sent off by road and the remaining
equipment abandoned. Although attempts were made to salve
some of it the lorries were unable to get beyond Ham. At Roye
the personnel was distributed to the casualty clearing stations
there, and also to the entraining centre at Villers Bretonneux.
On the 24th March the unit was ordered to Vecquemont, but
the stores had been sent to Moreuil, where schools were taken
over and equipped. Such stores as had been taken to Vec-
quemont were also brought back to Moreuil on the night
of the 25th/26th. On the 27th the unit was moved to Namps,

GERMAN OFFENSIVE AGAINST FIFTH ARMY 217

dumping part of the stores midway between that place and
Moreuil. It remained at Namps till the 22nd April, receiving
and treating most of the casualties brought there. Between
the 27th March and 2nd April the records of the unit give the
following statistics : —

Date.

Admitted.

Evacuated.

Died.

Remaining.

27th March

2,080

440 by road

1,920

28th

1,332

2,323

429

29th

2,791

1,464

735

30th „ .

2,641

2,681

31st

1,780

2,054

1st April

1,212

1,014

168

2nd „

502

584

—

The Lucknow CCS. commenced to move from Peronne la
Chapellette to Maricourt Plateau on the 22nd March. At first
only one section was ordered there, but at 11 p.m. the second
section was ordered to move by the D.M.S. There were only
two lorries available for transport, and as it took six hours to do
one return journey it was calculated that twenty-four hours
would be required to move a section. At 1.30 p.m. on the
23rd March machine guns came into action near the hospital,
and at 2 p.m. the commanding officer and the remainder of the
personnel set off across country, reaching Maricourt about 8 p.m.
Lorries returned about 2.30 p.m. but came under heavy fire and
two drivers were wounded. The equipment still left at Peronne
la Chapellette was consequently abandoned. From this time
the unit was guided in its work chiefly by the officer commanding
No. 38 CCS., who informed it at 3 a.m. on the 24th March that
the enemy was approaching. An officer was despatched to
obtain instructions from the D.M.S. As communication with
the D.M.S. appeared hopeless the officer commanding retired
with his personnel to Corbie. After reaching Corbie he reported
his arrival to the D.M.S. and was placed under arrest for leaving
Maricourt without orders and before clearing his patients* A
party from the British personnel of the unit then returned to
Maricourt and with the aid of a few cars of No. 10 M.A.C
completed evacuation of the patients, who were taken to Villers
Bretonneux by 3 a.m. of the 25th March. The unit was then
ordered to Vecquemont, but failed to salve all the equipment

He was subsequently released.

218 MEDICAL HISTORY OF THE WAR

left at Maricourt. It then came under orders of the D.M.S.,
Third Army, and was moved to Pont Remy near Abbeville on
the 29th March.

No. 38 CCS. detrained at Maricourt Plateau from Italy on
the 19th March, and commenced to open at once. Accommo-
dation for 400 was ready on the 21st and 17 nursing sisters were
sent to it on the 22nd. It received 1,105 wounded on the 22nd,
1,204 on the 23rd and 73 on the 24th, evacuating all by
ambulance trains or temporary ambulance train except 10
moribund cases, before it received orders on the 24th to close
and move to La Neuville near Corbie, where it opened under the
command of the D.M.S., Third Army, the following day. Forty
lorry loads of stores were got away during the 24th and night of
the 24th/25th March, but about half the tentage had to be
abandoned.

After Tincourt, Ham and Cugny had been abandoned,
Marchelepot, Noyon and Roye became the chief centres to
which wounded were sent during the first three days of the
battle, more especially Marchelepot, to which all the surgical
teams from the lines of communication, ten in number, had
been brought by the D.M.S. Arrangements for taking the
teams over at No. 42 Stationary Hospital, Amiens, and dis-
tributing them on their arrival there in cars of the Army had
not been made according to the instructions issued by the
D.G.M.S. on the 6th March.* Consequently they were kept
at Amiens during the whole of the day of the 21st March,
having arrived there in cars driven by women drivers from the
bases. Operative surgery, however, had to be reduced to a
minimum at Marchelepot, as both of the casualty clearing
stations, Nos. 32 and 34, were crowded with wounded, who
had to be got ready for immediate evacuation, and the per-
sonnel had to devote their whole attention to this. The O.C
of No. 32 CCS. left Marchelepot on the 23rd March, on his
own initiative, with his personnel and 96 patients owing to the
heavy shelling in the neighbourhood, the cutting of the railway
communications, and the possibility of heavy fighting in the
vicinity. He handed over his patients to No. 41 Stationary
Hospital at Gailly and was ordered to Namps by the D.M.S.

* The D.M.S. of the Fifth Army informed the D.G.M.S. office by telephone
on the morning of the 21st March that the teams would be sent to the C.C.Ss.
by the cars in which they would arrive from the base, but, as the drivers of
these cars were women, who did not know the roads and whom the D.G.M.S.
expressly wished to go no farther forward than Amiens, the teams were
detained at Amiens until suitable arrangements for distributing them to the
C.C.Ss. had been made by the Army D.M.S,

GERMAN OFFENSIVE AGAINST FIFTH ARMY 219

on the 25th March. The stores and equipment at Marchelepot
were abandoned. No. 34 CCS. remained until the last of
the wounded had been evacuated by ambulance train, tem-
porary ambulance train and car and then hurriedly departed
in a temporary train at 9.45 p.m. on the 23rd March, with
only a small quantity of operating room equipment, the
army ophthalmic centre equipment, and the office records.
The remaining stores were abandoned. The personnel and
such stores as had been saved were ordered to the entraining
centre at Villers Bretonneux. The unit was sent on to Namps
on the 25th March.

The D.M.S. of the Army was not satisfied with the casualty
clearing stations leaving Marchelepot without orders from
him, but there was lack of communication and the railway
staff feared that the line would be broken and no further trains
possible. Between 5,000 and 6,000 wounded passed through
the two casualty clearing stations there on the 21st, 22nd and
23rd March, and all were got away before the enemy arrived.

After Marchelepot was abandoned, wounded were directed
to Rozieres, where No. 47 CCS. was established, reinforced by
the personnel of Nos. 5 and 55 C.C.Ss. from Tincourt, nursing
sisters of No. 61 CCS. from Ham, and surgical teams from
various units. Wounded began to arrive at Rozieres at
8.45 a.m. of the 22nd March and continued arriving in a
steady stream till the 26th, when orders came for the CCS.
to retire. The wounded were then sent to No. 41 Stationary
Hospital, Gailly, and to the entraining centre at Villers
Bretonneux. Some twenty of the patients had to be carried
at the last moment by hand as far as Harbonnieres. All the
operating instruments and surgical team equipment were
saved and taken to Amiens, but the remainder of the stores
was abandoned. On the 27th March No. 47 CCS. went
to Namps.

The casualty clearing stations in the southern sector, No. 46
at Noyon, and Nos. 50 and 53 at Roye, were cut off for
some time from telephone communication with the D.M.S.
Consequently the D. D.M.S. of the Illrd Corps gave instructions
for Noyon to be cleared on the 24th March, but a message
reached No. 46 CCS. at 10 p.m. from the D.M.S. ordering
the unit to remain, as the military situation, so the message
said, was much better. However, at 4 a.m. of the 25th another
message came through to send the nursing sisters to Amiens.
There were then some 1,500 wounded in the casualty clearing
station. Several hundred walking wounded broke away from

220 MEDICAL HISTORY OF THE WAR

the unit and followed some lorries which had been placed at
the disposal of No. 46 Casualty Clearing Station by the French.
By the help of these lorries, twenty-four ambulance cars, two
journeys of No. 22 M.A.C. and a train, the whole of the patients
were got away on the 25th March to Hargicourt before the
Germans arrived. The personnel was ordered to Picquigny
on the 27th March, but very little equipment had been salved.
The work of this casualty clearing station at Noyon was
particularly heavy, over 5,500 wounded being admitted between
the 21st and 25th March. At one time, on the 24th March,
nearly 3,000 wounded were in the unit. Many had to be
accommodated on the ground in the open air, but the weather
was fortunately fine and blankets and ground sheets were
abundant.

The two casualty clearing stations at Roye remained there
until the 26th March, when the place was evacuated under
enemy fire and the personnel transferred to Hargicourt.
Wounded had been arriving in large numbers owing to the
closing of the casualty clearing stations in more advanced
positions, but they were all cleared by motor cars, lorries,
artillery limbers, and any available transport passing to the
rear. Many were also cleared by No. 22 M.A.C. No trains
had reached Roye after 4 p.m. on the 25th March. The
nursing sisters had been sent to Hargicourt on the night of
the 23rd/24th March. They and the rest of the personnel
went to Namps on the 27th March. The equipment of the
units had been abandoned and the personnel, while at Namps,
assisted in the work of No. 41 CCS.

During these movements of the casualty clearing stations
of the Fifth Army a large entraining centre was established
under Lieut. -Colonel Turner, the officer commanding No. 61
CCS., at Villers Bretonneux, and another at Roye under
Lieut. -Colonel Edwards, commanding No. 41 CCS., from the
23rd to the 26th March, when the entraining centres were
transferred to Namps and Hargicourt. Namps eventually
became the locality at which all the casualty clearing stations
with such equipment as had been salved were concentrated,
except No. 5 and No. 46, which went to Picquigny on the
Somme, between Amiens and Abbeville. The equipment at
Namps was pooled and used by No. 41 and No. 55 C.C.Ss. which
were opened for the reception and treatment of wounded.
The personnel of Nos. 50 and 53 C.C.Ss. was attached for
duty in them. No. 61 CCS. personnel, assisted by the
personnel of Nos. 32 and 34, formed an entraining and

GERMAN OFFENSIVE AGAINST FIFTH ARMY 221

evacuating centre, and the whole of the units in Namps
were placed under the direction of Lieut. -Colonel Turner, as
Senior Medical Officer.

A subsidiary entraining centre was formed at Montieres
on the 28th March, and No. 47 CCS. was sent there.

No. 4 CCS. was transferred complete from Dozinghem in
the Ypres area to reinforce the Fifth Army, the D.M.S.
allotting it to Vecquemont, but when the area north of the
Somme came under the Third Army it was left there in the
trucks pending its movement to another site.

No. 41 Stationary Hospital was moved from Gailly to
Amiens on the 26th March and took over the buildings and
equipment of No. 42 Stationary Hospital. It left Amiens,
however, two days later for Fouilloy.

The general position and movement of the casualty clearing
stations of the Fifth Army during the German offensive may
be followed by reference to the sketch map.

It would appear from this record of the movements of the
casualty clearing stations in the Fifth Army that there was no
clear indication beforehand of the positions to which they
could usefully be withdrawn. In fact during the last week of
March the D.M.S. or his staff were engaged in searching for
suitable sites, instead of having had them already marked down
for successive retirements. But, disregarding these defects in
medical strategy, there stands out the one great fact that, owing
to the energy and initiative of all ranks, no patient admitted
to a casualty clearing station of the Fifth Army was abandoned
and all, except those who died before evacuation, were got
away.

The mobile laboratories were all moved back during the
offensive without loss of equipment, but of the two advanced
depots of medical stores all the stores of No. 13 were
abandoned at Ham and most of the stores of No. 14
at Peronne la Chapellette. No. 18 Advanced Depot was
consequently transferred from the Second to the Fifth Army
on the 27th March and went to Namps, but was immediately
moved back to Fouilloy and then to Longpre.

The Medical Services with Corps.
The medical services of the corps and divisions of the
Fifth Army worked smoothly and well, and the retirement
of regimental aid posts, advanced and main dressing
stations, which successively fell back on one another, appears
to have presented no difficulty.

222 MEDICAL HISTORY OF THE WAR

The Illrd Corps. — The headquarters of the Illrd Corps
were at Ugny-le-Gay on the 21st March with No. 24 M.A.C
attached to it. Battle stations had been organized beforehand,
and successive zones of withdrawal defined. On the 23rd
March the D.D.M.S. (Colonel S. Macdonald) had withdrawn
to Noyon, and, as the corps was then retiring in the direction
of the French area, he took, on his own initiative, control of
the casualty clearing stations at Noyon and Roye. Wounded
of the corps were being evacuated from these casualty clearing
stations to French hospitals at Compiegne. Colonel Macdonald
established a dressing station at Royallieu and made arrange-
ments with the French for the reception of British wounded
into their hospitals. Field ambulances were consequently
instructed to evacuate the wounded to Royallieu or from the
northern sector of the Illrd Corps to the French hospital
at Ressons-sur-Matz. The D.D.M.S. also arranged to draw
dressings and drugs from French stores at Creil. Up to the
29th March all wounded of the corps continued to be
evacuated through the French hospitals. On that date the
D.D.M.S. received instructions to evacuate them, if possible,
to Namps. The corps rejoined the Fifth Army on the 30th
March leaving, however, the 58th Division with the French.
Up to that time many wounded officers and men of the Illrd
Corps were cleared by French ambulance trains and distributed
to French hospitals in the interior. They went to all parts of
France. The particulars of each admission were sent by the
French authorities to the British Military Attache in Paris,
who sent the forms to D.G.M.S. at G.H.Q. Steps were then
taken through the D.M.S., L. of C, to have the patients trans-
ferred, as soon as their condition permitted, to British hospitals.
The French records of each admission were then forwarded
to the base record office at Rouen.

There appears to have been no difficulty in the Illrd Corps
in collecting and bringing the wounded during the retreat
back to main dressing stations and C.C.Ss., and there is no
record of a breakdown at any time. The policy of the D.D.M.S.
was to distribute the cars of No. 24 M.A.C. to divisions, retaining
a minimum reserve of twelve cars at the headquarters of the
convoy under his own control.

Arrangements were also made for a medical lorry park
being formed of twenty-two lorries at Villequier Aumont,
whence they were to be distributed under orders of the
D.D.M.S. by the O.C. of No. 24 M.A.C. Some of these lorries
were to be distributed to the walking wounded collecting

GERMAN OFFENSIVE AGAINST FIFTH ARMY 223

stations of the divisions for clearing the walking wounded to
the corps rest station or to the casualty clearing station at
Noyon. The O.C. of the medical lorry park was to be respon-
sible for ensuring an adequate supply of lorries for rapid and
smooth evacuation.

Much of the success of the medical work of the corps appears
to have been due to the D.D.M.S. having this medical lorry
park placed at his disposal. The total number of lorries
allotted to him was thirty, two each being sent, on the receipt
of the orders to prepare for attack, to each of the four walking
wounded collecting stations, while the remaining twenty-two
were parked, as already noted, at the headquarters of the
medical lorry park.

Strong points in the battle zone were supplied with medical
emergency boxes, which were not to be used except in the
case of attack. They contained shell and field dressings,
splints, bandages, cookers, with a certain amount of medical
comforts, stretchers and Thomas' splints, and anti-tetanic
serum. They were to be held as trench stores. Wounded
were to be cleared from these strong points by the bearers
detailed from field ambulances whenever the situation per-
mitted, but on no account was the garrison allowed to be
depleted for bringing them back.

Between the 21st and 25th March there were many casualties
in the R.A.M.C. of the corps, as shown in the following table : —

Casualties in the R.A.M.C. of the Illrd Corps.

Division.

Killed.

Wounded.

Missing.

Gassed.

Total.

Offs.

O.R.

Offs.

O.R.

Offs.

O.R.

Offs.

O.R.

14th Div.
18th Div.
58th Div.

1
1

22
3

57
22

—

27
13

Total . .

—

131

The XV I Ilth Corps.— The XVIIIth Corps, which retired
on the left of the Illrd Corps from Ham through Nesle to
Moreuil between the 22nd and 25th March, and to St. Sauflieu
on the 27th March, eventually handed over all its divisions to
the XlXth Corps on the 29th March, and on the 2nd April
was withdrawn from the battle front. The evacuation of
its sick and wounded also worked smoothly and well. Field

224

MEDICAL HISTORY OF THE WAR

ambulance transport, No. 31 M.A.C., and motor lorries con-
veyed them in the direction of Noyon, Roye and eventually
Hargicourt and Namps. In accordance with the instructions
of the D.M.S. the advanced dressing stations were to be
evacuated direct to the casualty clearing stations, and the
D.D.M.S. of the corps consequently arranged for No. 31 M.A.C.

DIAGRAM SHOWING THE FIRST AND SECOND SYSTEMS OF USING
CARS OF N° 31 MOTOR AMBULANCE CONVOY WITH THE XVI||™ CORPS

System N°- !

System N°- 2

Q DIVISIONAL DRESSING STATIONS AND
^f-^ WALKING WOUNDED COLLECTING. STATIONS

MOVING FROM PLACE. TO PLACE

/<j>V ADVANCED HEADQUARTERS OF THE

¥& MOTOR AMBULANCE CONVOY

♦

REAR HEADQUARTERS OF THE
MOTOR AMBULANCE CONVOY

CASUALTY CLEARING STATION

<T0

to be reinforced by five of the motor cars of each division in
the line and all but the Ford cars of the division in reserve.
This worked well during the first day of the battle, but there
was great difficulty afterwards in maintaining communication
with the A.Ds.M.S. of divisions. The D.D.M.S. then reversed
his policy, and on the 23rd March placed five motor ambulance
cars of No. 31 M.A.C. and four motor lorries, each seating

GERMAN OFFENSIVE AGAINST FIFTH ARMY 225

twenty-five walking wounded, at the disposal of each A.D.M.S.,
leaving a reserve of cars and lorries with No. 31 M.A.C. to be
sent out on request. These arrangements worked well, and
when the casualty clearing stations were concentrated at
Namps, a system of clearing the advanced dressing stations
by relays was adopted. The motor ambulance convoy had
a rear and advanced post ; when a loaded car went back an
empty car was at once sent forward from the advanced post,
and in order to make this system more effective the advanced
post was established at a relay point, through which all cars
coming back with wounded from the dressing stations passed
on their way to the casualty clearing stations, as shown in the
diagram of the earlier and later systems on the previous page.
There is no record of the losses amongst the R.A.M.C. in
this corps, and the records of the wounded admitted to its
medical units are not complete, but the following table shows
such figures as were noted at the time : —
Summary of wounded admitted to medical units of XVIIIth

Corps during the period 12 noon 2\st March 1918 to noon

31st March 1918.

Date.

Officers.

Other ranks.

March 1918.

21st to 22nd

789

22nd to 23rd

151

23rd to 24th

24th to 25th

253

25th to 26th

26th to 27th

236

27th to 28th

583

28th to 29th

225

29th to 30th

191

30th to 31st

683

Totals

201

3,280

The XlXth Corps. — The headquarters of the XlXth Corps
were at Villers Carbonnel, south of Peronne and west of the
Somme Canal on the 21st March. The medical arrangements
made by its D.D.M.S. were similar to those of the XVIIIth
Corps, and evacuation of wounded by ambulance cars and
lorries worked smoothly. No. 10 M.A.C. was allotted to the
corps. The chief point in the medical arrangements issued
on the 20th March was in connexion with the use of lorries.
Six were to work from Roisel, along the Roisel-Tincourt road,

226 MEDICAL HISTORY OF THE WAR

and as each lorry was capable of making six trips in twenty-four
hours, the six lorries could make a total of thirty-six trips,
carrying 720 patients in all. Similarly six more lorries were
to work from Montigny, capable of making three trips each
in twenty-four hours, carrying a total of 360 patients ; and
twelve lorries to work from Vermand, making three trips each,
carrying a total of 720 patients. A total of 1,800 walking
wounded could be removed in this way in twenty-four hours.

It was further calculated that the light railway would
bring back some 500 patients from Montigny and Roisel to
Tincourt in five journeys daily.

The general arrangements in the XlXth Corps were for
the casualties to be brought back from the regimental aid
posts by hand carriage to the advanced dressing stations,
and from the advanced dressing stations direct to casualty
clearing stations by means of ambulance cars, light railway
and lorries or buses. There were nine regimental aid posts,
four on the left sector, two in the centre and three on the
right sector.

The field ambulance posts were established at the following
places just before the attack : —

Advanced dressing stations : —

Templeux and Roisel for the left sector.
Jeancourt for the centre.
Vermand for the right sector.

Walking wounded collecting posts : —

Templeux and Roisel for the left sector.
Montigny Farm for the centre.
Vermand for the right sector.

Gas Centres on left and right sectors at the A.D.Ss.

Gas Treatment Centre at Bernes.

Corps Rest Station and Scabies Station at Doingt.

Evacuation was to Tincourt for lying cases, Marchelepot
for walking wounded and head cases, and Gailly for N. Y.D.N.
and self-inflicted injuries.

Thirty lorries or buses for twenty sitting cases each were
supplied by the XlXth Corps, six, or a total of eighteen, being
allotted, as noted above, for collecting from each of the walking
wounded posts ; one was allotted to the gas centre at Bernes ;
and the remainder were parked as a corps reserve at Cartigny.

A light railway to Tincourt was to have brought the wounded
back to the casualty clearing stations there from the northern
sector of the corps ; but the closing of these casualty clearing
stations immediately after the attack upset the arrangements,

GERMAN OFFENSIVE AGAINST FIFTH ARMY 227

and the wounded had then to be taken by road to Marchelepot,
which in its turn was closed for casualties of the XlXth Corps
on the first day, Rozieres being assigned for their reception
after the 21st.

The D.D.M.S. moved back to Foucaucourt on the night
of the 22nd/23rd March and on the 24th to Harbonnieres.
An attempt was made by him to salve the equipment of the
casualty clearing stations at Marchelepot on the 24th under
orders from the D.M.S. of the Fifth Army, but lorries were
refused for this purpose, as the enemy was approaching the
place and it was reported to be in flames. On the night of the
24th/25th March the casualty clearing stations at Rozieres
were closed and wounded of the corps were then sent to Villers
Bretonneux, the corps headquarters moving there on the
25th. On arrival at Villers Bretonneux the D.D.M.S. found
3,000 wounded, chiefly walking cases, and endeavoured to
expedite the arrival of ambulance trains. Villers Bretonneux
and No. 41 Stationary Hospital at Gailly, which was also
receiving wounded of the corps, were closed by the D.M.S.
of the Army, who instructed the XlXth Corps D.D.M.S. on
the morning of the 26th March to send his stretcher cases
to Amiens and walking cases to Hargicourt until 8 a.m. of
the 27th March, after which time all casualties were to go to
Namps.

On the latter date at 11.35 a.m. the D.D.M.S. of the XlXth
Corps received a message from the D.M.S. ordering him to
make medical arrangements for the force afterwards known
as Carey's force, which had been hurriedly formed of con-
valescents and others to hold a line between Villers Bretonneux
and the Somme. The 2/2nd Northumbrian Field Ambulance
of the 50th Division was consequently attached to the force.
The officer commanding this ambulance sent his wounded to
Villers Bretonneux station on the 27th, and had arranged
with the Railway Transport Officer there to load them on
an empty ammunition train under the charge of a medical
officer and some other ranks. Unfortunately this train was
sent to the base instead of to Namps. This appears to have
been the only instance of wounded being sent back in a supply
train to the base during this period. Subsequently the XlXth
Corps held the line in front of Amiens between the Somme
and the Luce, until withdrawn by the middle of April to a
back area.

The Vllth Corps. — The Vllth Corps headquarters, which
had been at Templeux-la-Fosse, moved back on the night

228 MEDICAL HISTORY OF THE WAR

of the 2 1st /22nd March to Maricourt and the following day
to Corbie. The 39th and 16th Divisions, however, retreated
to the south of the Somme and joined the XlXth Corps,
while the Vllth Corps was placed under the Third Army.
Two Australian divisions joined it at the end of March and it
was relieved on the 6th April by the Australian Corps and went
to a back area of the Third Army. When the D.D.M.S.
came under the Third Army administration he was instructed
to send his wounded to the stationary hospitals at Gailly
and Amiens, as the casualty clearing stations in the Third
Army were all moving at the time and the casualties of the
Army were being sent to Doullens.

Twenty lorries had been lent by the Third Army to the
corps for clearing walking wounded, but they were taken
away on the night of the 31st March without reference to
the D.D.M.S. or Corps Headquarters. This upset the whole
scheme of evacuation of walking wounded. The D.D.M„S.
was able, however, to keep back five of the lorries, and was
promised more in the event of active operations again starting.
He was much harassed by this interference with his arrange-
ments and at not being able to count on their holding good
for more than a day or so at a time.

While the Vllth Corps was in the Fifth Army, forty lorries,
together with No. 3 M.A.C, were placed at the disposal of
the D.D.M.S. in anticipation of the attack. The lorries were
to be distributed as thought necessary by the O.C. of No. 3
M.A.C. Consequently, at the commencement of the operations,
the ambulance cars of the convoy were distributed as follows : —
24 ambulance cars to a dressing station at V.18.C, and
20 to a dressing station at Villers Faucon.
2 cars to a W.W.C.P., at Longavesnes.
8 cars to an advanced park at Tincourt.
8 cars to the main park at Peronne.
The forty lorries were placed : —

12 at the W.W.C.P. at V.18.C.
15 at the W.W.C.P. at Longavesnes.
8 parked as a reserve at Nurlu, and 5 at Hamel.
The headquarters of No. 3 M.A.C. were at Peronne.
The Cavalry Corps. — The Cavalry Corps had been reduced
to three cavalry divisions before the German offensive of
1918, the Indian units of the 4th and 5th (Indian) Cavalry
Divisions having been transferred to Egypt. The corps had
held till 9th March the sector subsequently occupied by the

GERMAN OFFENSIVE AGAINST FIFTH ARMY 229

XlXth Corps. Its headquarters were after that date at
Villers Bretonneux, with advanced headquarters at Villers
Carbonnel. The corps came under the Third Army on the
27th March, but returned to the Fifth Army three days later.
Its divisions were employed in various sectors and moved
from one corps and one army to another as the situation
demanded. The A.Ds.M.S. all complained, in these circum-
stances, of the difficulty of bringing up personnel and equipment
to the scene of action with the horsed vehicles allotted to
the cavalry field ambulances. The horses of the ambulance
wagons became exhausted after bringing up personnel and
were of little use afterwards for evacuating wounded. There
is no mention, however, of the motor ambulance transport
of these cavalry field ambulances. When the cavalry field
ambulances worked in proximity to field ambulances of divi-
sions, their tent divisions or main dressing stations were not
wanted, and the A.Ds.M.S. suggested that the equipment of
these might well be left behind in order to set free transport
for personnel.

The Medical Services of Divisions.

With regard to the medical services of the divisions com-
prising the corps of the Fifth Army during the retreat
details are very incomplete, but from careful reports
drawn up by the A.Ds.M.S. of five of the divisions
it would appear that it was only during the first two
days that it was found difficult or impossible to collect
all the wounded. The defence scheme defined three lines
of resistance : a line of thinly held outposts, a main battle
line of a zone of fortified keeps composed of a chain of mutually
supported strong points and a trench line behind, about
3,000 yards from the line of outposts, and a third line of defence
about 3,000 yards still further back. Advanced dressing
stations were organized in connexion with each of these lines,
and the fortified keeps were supplied with dressings, medical
comforts, stretchers, blankets, splints and orderlies, but not
with medical officers. Many of these keeps were surrounded
and captured on the 21st March, and numbers of wounded
thus fell into the hands of the enemy. The general schemes
prepared by the divisional A.Ds.M.S. were based on the
assumption of getting wounded back from the advanced
dressing stations to the casualty clearing stations as rapidly
as possible, but their calculations were completely upset by
the closing of the forward casualty clearing stations, such as

230 MEDICAL HISTORY OF THE WAR

those at Cugny and Tincourt, practically before the enemy
attack was launched, thus necessitating a long journey back
from advanced dressing stations to the casualty clearing
stations in back areas. This was the real defect in the
organization, as there were no echelons of main dressing
stations prepared for such a contingency.

After the first two days, however, no difficulties seem to
have arisen in the Fifth Army divisions, and wounded were
systematically collected and taken back, one divisional A.D.M.S.
noting that the rate of retirement was sufficiently slow, namely
about 1,000 yards in an hour, to admit of this being done.
The roads were in good condition up to regimental aid posts,
as the latter were falling back on undamaged areas, and the
motor ambulance cars were able to go up to them or near
them ; but the long carry back to casualty clearing stations
without intermediate main dressing stations, and the resulting
withdrawal of divisional ambulance transport from the control
of divisional A.Ds.M.S. and pooling it with the ambulance
transport of motor ambulance convoys caused immense
anxiety to many divisional A.Ds.M.S. and field ambulance
commanders in their efforts to clear the wounded from
advanced dressing stations before the latter were obliged to
retire.

On this point the A.D.M.S. of the 66th Division of the
XlXth Corps makes the following remarks on the evacuation
of dressing stations. His advanced dressing stations were,
at the time of the attack, at Templeux and Jeancourt, and
withdrew according to plan to successive positions, the distance
from the original front line to the final line when the corps
was relieved on the night of the 30th/31st March being
thirty miles : —

" All through the whole eleven days, one of the greatest worries and
anxieties was the difficulty in getting dressing stations evacuated of
casualties before withdrawing from them. From the beginning to the
end, there never once was a regular service of ambulances for the purpose
of evacuation. It was only as the result of repeated appeals to the
D.D.M.S. and to the M.A.C. direct under instructions from the D.D.M.S.
that ambulances or lorries were obtained. Sometimes an officer had to
go to the M.A.C. in person to ensure the arrival of some ambulances at
the dressing station.

" It no doubt happened that vehicles, detailed to report to one dressing
station for evacuation, were utilized by other units. It frequently
happened that there were two or even three dressing stations, belonging
to different divisions, in one village.

" Divisional motor ambulances had to be used to a very considerable
extent for evacuating to casualty clearing stations. Owing to the fact
that casualty clearing stations had to be closed very early, the journeys
to those receiving were very long. In some instances divisional motor

GERMAN OFFENSIVE AGAINST FIFTH ARMY 231

ambulances were absent on one journey eighteen hours. This procedure,
wrong in principle, but necessary under the circumstances, involved the
risk that it might not have been possible to clear some particular front
area of casualties, that being the work for which the divisional motor
ambulances should have been held available.

" Also the officer responsible for clearing the front area of casualties
was saddled with a constant anxiety that he might not be able to get
all his cases away from the dressing station before he had to withdraw
from it, at a time when all his energies should have been concentrated
on the work of clearing the area in front. That was often a very real
anxiety indeed.

" In spite of the difficulties that had to be overcome, as far as is known,
every area was cleared of all casualties before the troops withdrew,
and in every instance the dressing stations were evacuated of all casualties,
before the field ambulance personnel withdrew to another site.

" A feature of the work of clearing casualties from the forward area,
in open warfare, is the extensive use that can be made of motor ambu-
lances for that purpose. Shelling was not very heavy after the 21st
March, and roads for the most part were undamaged. Motor ambulances,
particularly Fords, could be run close up to the front line. The conse-
quence was that hand carries were much shorter than has ever been
experienced, even in normal trench warfare.

" Horsed ambulances also were very useful for conveying sitting cases
back to the dressing stations.

" The fact that motor ambulances could be used in this way in the
forward area made it possible to fix sites well back for dressing stations.
That was very desirable in view of the instability of the line, enabling
the personnel at the dressing stations to have longer periods of fixity of
location."

< 101 34)

CHAPTER XIV.

THE GERMAN OFFENSIVE AGAINST THE THIRD ARMY IN 1918.

THE withdrawal of the casualty clearing stations of the
Third Army, immediately after the German attack was
launched, was more methodical and followed on more clearly
defined lines than the withdrawal of these units in the Fifth
Army, but became greatly embarrassed by the interruption
of traffic on the Albert-Amiens line of railway after the 25th
March. The loss of equipment and stores was comparatively
small, and only No. 48 and the Lucknow C.C.Ss. had to be
sent to the base to refit. The D.M.S. had arranged for nine lorry
loads of equipment to be ready in each of the more advanced
casualty clearing stations as a mobile section for immediate
withdrawal to selected sites further back ; but he had also
been allotted additional lorries, and was consequently able
with them to save more equipment than would otherwise
have been possible. The enemy's rapid advance, however,
in the southern sectors of the army made it impossible for him
to retain the casualty clearing stations in his second line and
they had to fall back almost at once on Edgehill. As had
been anticipated, Edgehill then became the chief centre at
which wounded from the southern sectors were concentrated ;
but by the 26th March the position there was so dangerous
that it too had to be abandoned, and practically all the sick
and wounded of the corps engaged were then diverted to
Doullens and Gezaincourt. The course of events may best
be followed from the movements of the casualty clearing
stations.

The Casualty Clearing Stations.

Ytres was the most advanced of the casualty clearing
station sites. No. 48 CCS. remained open there till the last
moment. The site of this casualty clearing station and its
vicinity were heavily shelled throughout the 21st March,
but it remained open, admitting streams of wounded all day
from 6 a.m. onwards. The situation was reported to the
D.M.S. at noon, and orders were issued by him to close and
move to Edgehill. The sisters were sent away that evening.

MOVEMENT OF CASUALTY CLEARING STATIONS OF THIRD ARMY DURING GERMAN OFFENSIVE, SPRING 1918.

Scale of miles

12 3 4-

5 6 7 8

4-2 Stationary Hospital
to Abbeville 26/3.

AMIENS

MaJbv&Sons.Lrth

GERMAN OFFENSIVE AGAINST THIRD ARMY 233

During the night of the 2 1st /22nd as many of the wounded
as possible were evacuated by ambulance train, and the
remainder, 267, were cleared to Edgehill by twenty cars
sent by orders of the D.M.S. and by nine lorries obtained
locally. A train of nineteen trucks arrived at 2 a.m. of the
22nd March, and all but three of the trucks were loaded up
when the train was obliged to leave at 2 p.m., only a neg-
ligible quantity of stores being abandoned. It reached
Edgehill about 6 p.m., where it was unloaded, and No. 48
CCS. ordered to open at once for walking wounded.

On the 24th March a party of five medical officers and
forty other ranks of No. 48 CCS. was ordered to proceed
to No. 3 (Canadian) Stationary Hospital, Doullens, with
surgical equipment. They went by train to Amiens, and from
there marched to Doullens, leaving their equipment at No. 42
Stationary Hospital at Amiens. They reached Doullens
during the night of the 26th/27th March. A lorry was then
sent to Amiens to bring on the equipment. The remainder
of thi unit was ordered to entrain for Doullens at 11 p.m.
on the 24th, leaving the equipment behind, with the exception
of two lorry loads of documents and some other equipment,
which were to go on by road to Doullens. The train with
the personnel was held up at Bonnay for several hours in a
block of trains on the 25th March, and as there seemed little
prospect of going on, the O.C detrained his personnel and
marched them to Doullens, where they were employed in
No. 3 (Canadian) Stationary Hospital. On the 8th April,
the O.C, Quartermaster and twelve other ranks were sent
to Boulogne to refit the unit, and the remainder of the
personnel rejoined them there on the 13th May. The unit
was then again complete. It was transferred to the IXth
Corps in the French area and opened at Montigny-sur-Vesle,
where, at the end of May during the German offensive on the
Aisne, it had again to abandon its equipment and returned
to Rouen to refit.

No. 21 CCS. had been withdrawn from Ytres before the
attack to a new site at Beaulencourt, where its equipment began
to arrive at the beginning of March. Most of the personnel,
however, were attached for duty to No. 48 CCS. The equip-
ment at the time of the attack had been taken on light railway
trucks to the new site, but much of it had not been unloaded.
The personnel attached to No. 48 CCS. rejoined No. 21
CCS. early on the 22nd March and the unit then received
orders to move from Beaulencourt to Edgehill. Seven lorries

234 MEDICAL HISTORY OF THE WAR

and six ambulance cars arrived to remove unloaded equipment
about midday, and the O.C. was able to bring away on them
and on his own two lorries seventy-five patients, X-ray outfit,
a complete theatre and dressing room outfit, sixty beds and
mattresses complete, about 350 stretchers, 1,600 blankets,
medical and surgical panniers, dispensary equipment, two
large marquees and eight bell tents, thus demonstrating the
value of having a mobile equipment, which could be carried
on nine lorries, according to the instructions of the D.G.M.S.
of September 1916. Edgehill was reached in the evening.
The unit did not open at Edgehill, but had orders to stand
by, re-equip from the stores kept by the D.M.S. of the Army
in a dump at Edgehill and be ready to move. Attempts
were made to salve the remainder of the equipment left on
the light railway trucks at Beaulencourt. Fourteen lorries
were sent off for this purpose on the 24th March, but they
were stopped by a countermanding order while on their way,
and the unit ordered to entrain with the equipment of No. 29
CCS. from Edgehill. For three days it remained on the
train, being moved from place to place and eventually reaching
Auxi-le-Chateau on the 26th March. The following day it
was unloaded in a field on the Abbeville road and proceeded
to open there with a varied assortment of tentage and equip-
ment of its own and of No. 29 CCS. It was eventually moved
to Wavans, on the Auxi-le-Chateau-Doullens road as being
more convenient for entraining.

Both of the casualty clearing stations at Achiet-le-Grand
were open on the 21st March, but were heavily shelled from
about 5.30 a.m. till noon. Twenty-five of the personnel
belonging or attached to No. 45 CCS. were killed and eleven
wounded. The casualty clearing stations were ordered to
close and move to Aveluy ; the sisters and patients
being evacuated to Grevillers, as previously arranged.
Twenty-five lorries had been placed at the disposal of each
of the two units, and by continuous journeys were able to
concentrate at Aveluy practically complete by the 23rd March.

No. 45 CCS. partially opened at Aveluy for walking
wounded. It had salved everything except tent bottoms and a
few bell tents in eighty-two lorry loads. Orders were received
to stand by, and the equipment was stacked at the railway
siding ready to entrain. The unit entrained on the 24th
March and left for Doullens about 10 p.m. Its commanding
officer, Lieut. -Colonel Fitzgerald, proceeded by car to Doullens,
and was appointed to act as a temporary A. D.M.S. there
for controlling evacuation by train.

GERMAN OFFENSIVE AGAINST THIRD ARMY 235

The journey of No. 45 CCS. to Doullens was eventful.
At Albert the train was heavily bombed, and at Ribecourt
it was held up by a block on the line. The personnel was
detrained at Meaulte and marched from there to Doullens,
two of the officers and fifty other ranks remaining with the
equipment on the train. The train arrived at Doullens on
the 26th March and went on to Gezaincourt to unload.

The personnel who had marched to Doullens was sent
to Orville to inspect a site at the XHIth Corps signal school.
With the exception of officers and other personnel detached
for duty with No. 3 (Canadian) Stationary Hospital, Doullens,
the personnel remained in camp at Orville till the end of March.
On the 1st April the personnel left Orville and took over
the officers' hospital in the Chateau at Gezaincourt. In the
meantime, on the 30th March, the equipment and stores, which
had been detrained complete at Gezaincourt, were handed
over to other casualty clearing stations that had been with-
drawn there without their own equipment. On the 7th April
the unit was moved to Auchy-les-Hesdin, about three miles
north-east of Hesdin in the Ternoise valley.

No. 49 CCS. was removed from Achiet-le-Grand in fifty-
seven lorry loads to Aveluy, where it was under orders not
to open but to entrain. The train was loaded during the
night of the 23rd/24th March and left for Puchevillers, which
it reached at 7 a.m. on the morning of the 24th. Wounded
commenced to come in large numbers in the evening and by
midnight about 750 had arrived. Shortly afterwards the
site was heavily bombed. A long line of cars which had
brought the wounded was hit ; two of the cars were destroyed
and others damaged ; three men on them and a R.A.M.C
orderly were killed. The wounded were evacuated by am-
bulance trains the following day, but the casualty clearing
station remained open and admitted many more during the
25th and night of the 25th/26th March. At 10 a.m. of the
26th orders were received to close. Ten ambulance cars were
sent for removing patients to Doullens, and 240 were evacuated
by them. One hundred walking wounded were marched to
Doullens, and an ambulance train, which arrived in the evening,
evacuated the remainder. A truck train was loaded with
the equipment during the night and left at 8.30 a.m. on the
27th March, only some of the bulky stores such as bedsteads
being left behind. During the two days No. 49 CCS. was
open at Puchevillers it had admitted and cleared 1,550
wounded.

236 MEDICAL HISTORY OF THE WAR

The personnel of No. 49 CCS. left Puchevillers for Auxi-le-
Chateau by road. The train with the equipment went to
Doullens and did not reach Auxi-le-Chateau till the 29th
March. It was then sent on to St. Riquier, where No. 49
CCS. was finally established. By the 8th April the unit
was ready to accommodate 500. While it was being opened
the medical officers were attached to No. 3 (Canadian)
Stationary Hospital for duty. It was transferred at St. Riquier
to the Fourth Army on the 22nd April.

The next casualty clearing stations to move were Nos. 29
and 3 at Grevillers. No. 29 was ordered to close in the after-
noon of the 21st March and hand over its site to a field ambul-
lance. In the early morning of the 22nd nine lorries were
loaded with stores for a 300-bed unit, and the rest of the
equipment was placed on an empty ammunition train. The
personnel of No. 3 CCS. was sent away on this train, being
relieved by the personnel of No. 29, apparently because the
former had been worn out by the arduous work of dealing
with the large numbers of wounded which accumulated at
Grevillers after No. 29 had closed, as many as 3,627 wounded
and 300 sick having been admitted to it on the 21st and 22nd
March. No. 3 CCS. was then cleared of all patients. A
certain amount of its equipment was left behind and the rest
loaded on a second train at Grevillers during the night. Both
trains and the personnel of both units arrived at Edgehill
early in the morning of the 23rd March, and detrained there.

Consequent on these moves all the casualty clearing stations
east of Albert and the Ancre had been withdrawn with com-
paratively little loss of equipment ; and four of them, Nos. 48,
21, 3 and 29, were at Edgehill alongside No. 56 on the 25th
March. Lieut. -Colonel Rae, the O.C of No. 3 CCS., was
then appointed by the D.M.S. to act as S.M.O. at Edgehill,
and co-ordinate the work. Wounded were coming to Edgehill
in large numbers, and Colonel Rae adopted the plan of working
the personnel of each unit for a few hours at a time in relief
of one another.

There appears, however, to have been some confusion at
Edgehill owing to orders and counter-orders. The group
of casualty clearing stations was closed down in the morning
of the 23rd, but No. 48 was reopened. The O.C. of No. 29
was ordered to entrain his equipment at Edgehill and place
it in charge of No. 21 CCS. As already noted it left Edgehill
with the personnel of the latter on the 24th March, but the
orders to close the group at Edgehill were then countermanded

GERMAN OFFENSIVE AGAINST THIRD ARMY 237

and the group reopened. In the afternoon of that day the
following order was received by Lieut. -Colonel Rae from the
D.M.S., Third Army :—

" 56 and 48 C.C.Ss. are to close at once and hand over all cases to
3 CCS., together with buildings. No more cases will be taken in.
All will be diverted to Doullens. Two C.C.Ss. will pack up at once.
3 CCS. will evacuate all cases by A.T. as speedily as possible and then
pack up."

There was no mention in the order of Nos. 29 and 21, but
the D.M.S. clearly intended Edgehill to be closed and no more
wounded sent there. Its position was becoming dangerous in
consequence of the enemy's advance into the area between
the Ancre and the Somme. Some trucks were obtained at
10 p.m., and as much of the equipment of Nos. 48 and 56 as
they would hold loaded on to them. The wounded were all
cleared by ambulance train and temporary ambulance train,
except a few waiting evacuation by ambulance cars. It was
Lieut. -Colonel Rae's intention at first to send the personnel of
all the casualty clearing stations away by the train with the
equipment, but as no engine had arrived for it by 1 a.m.,
he ordered the personnel of Nos. 3, 29 and 56 to march to
Doullens, a small detachment of one officer and ten other
ranks of No. 3 being left behind to look after any wounded
who might arrive at Edgehill. The personnel of No. 48 had
already departed on another train, leaving the equipment
behind, as already noted.

A train had been sent to Edgehill in the early morning, and
also twenty lorries, which were to be loaded with the equipment
left behind at Edgehill. At Warloy, Lieut. -Colonel Rae, with
the O.C. of No. 56 CCS. and a party of other ranks from
No. 3 and No. 56, returned to Edgehill in cars of a motor
ambulance convoy, which had been diverted to Warloy for the
purpose, in order to salve the equipment. The remainder
of the personnel of these units and the personnel of No. 29
reached Doullens on the evening of the 25th March.

The party from No. 56 CCS. brought thirty- two lorry
loads of hospital equipment away from Edgehill to Gezaincourt.
There is no record of the equipment salved by the train, but such
equipment as had been got away was taken to Gezaincourt,
where Nos. 3, 29, and 56 C.C.Ss. assembled on the 26th March.
The equipment and tentage were pooled and the group of
three casualty clearing stations opened on what had been
the site of casualty clearing stations during the Somme battles
of 1916. No. 56 CCS. took over the records and reception
of the wounded, No. 29 was put in charge of the walking

238 MEDICAL HISTORY OF THE WAR

wounded, while No. 3 took over the seriously wounded and
the officers' hospital in the Chateau. With the stores of
No. 45 CCS. and such equipment as had been salved from
Edgehill each unit was more or less fully equipped for 500
patients and at the end of the month worked as separate units.

The number of sick and wounded received by this group
of casualty clearing stations between the 23rd and 30th March
was 2,101 according to the O.C of No. 56 CCS., who kept the
records. The number received during the previous two days
by No. 56 CCS. was 4,205 wounded and 49 sick.

There were still three casualty clearing stations in the
southern sector of the Third Army, namely No. 38, No. 4 and
the Lucknow, all of which had been taken over from the Fifth
Army with the Vllth Corps. No. 38 had been withdrawn
from Maricourt Plateau on the 24th March by the D.M.S. of
the Fifth Army, salving a considerable portion of its stores
but abandoning half its tent age. Forty lorry loads and
sixty-six ambulance car loads were brought to La Neuville,
Corbie, and the unit opened there on the 25th March. It then
came under the Third Army. On the 26th March the enemy
was said to be approaching, communication with the D.M.S.
was cut off, and the railway staff had been withdrawn. The
patients were evacuated by an ambulance train and also by
motor ambulance convoy to Amiens ; the stores were aban-
doned, and the personnel marched to Amiens. Corbie, how-
ever, although constantly under shell fire, did not fall into the
hands of the enemy, and during the remaining days of March
most of the equipment and stores were got away on lorries
and dumped at Vignacourt. The personnel was sent to Pont
Remy, and remained there until the unit went on 11th April
to Fienvillers.

No. 4 CCS. had been sent from Dozinghem under orders
from the D.G.M.S. to reinforce the Fifth Army. It arrived
by train, complete in every respect, on the 26th March at
Vecquemont, but did not unload. Lieut. -Colon el Rahilly,
who commanded it, took the precaution of keeping the engine
with the train, although the engine driver had no coal or
water. He had been unable to get in communication with
the D.M.S. of the Third Army, but collected all the coal he
could in the village and had the train moved down the line.
It was held up about six miles out, but eventually got away
to Abbeville, being bombed until it passed Amiens. At
Abbeville the D.A. & Q.M.G. of the L. of C gave him per-
mission to take over an Army Musketry School at Pont Remy.

GERMAN OFFENSIVE AGAINST THIRD ARMY 239

He arrived there on the 29th March, and opened on 1st April
with accommodation for 1,000, half in huts and half in marquees.

The move of the Lucknow C.C.S., which had come to
Vecquemont from Peronne-la-Chapellette and Maricourt, has
been described in the account of the moves of casualty clearing
stations of the Fifth Army. It was withdrawn to Pont Remy
by the D.M.S., Third Army, and was able to open there with
such equipment as it had salved. It should be noted, however,
that a detachment of the unit was with No. 22 CCS. at Bruay,
in the First Army area, for the reception of sick and wounded
Indian drivers of ammunition columns.

After the 26th March, consequently, no casualty clearing
stations of the Third Army were open south of Doullens
or east of the Doullens-Amiens road. Doullens and Gezain-
court were then the centres to which wounded were con-
centrating. No. 3 (Canadian) Stationary Hospital was crowded
with them, and was also receiving quantities of surplus
stores sent back there by medical units. Mobile laboratories
and personnel of other casualty clearing stations also found
their way there and were attached for duty.

The numbers admitted to and discharged day by day
from this stationary hospital in the Citadel, Doullens, were
as follows : —

Date.

Admitted.

Discharged.

March 1918.

21st

22nd

23rd

24th

25th

26th

27th

28th

29th

30th

31st

276

517

1,064

649

673

1,622

1,932

2,333

2,228

1,154

941

542

226

955

1,172

1,411

1,975

2,109

2,433

1,694

980

The hospital was visited by H.M. the King on the 29th
March, during the heaviest period of work.*

In April the admissions were not so numerous, although
on the 5th, 6th and 10th they exceeded 1,000.

* The King, during His Majesty's visits to the front, visited many other
medical units at various stages of the war, and in July 1917 Her Majesty the
Queen made an extended tour of the hospitals on the Lines of Communication
and at General Headquarters.

240 MEDICAL HISTORY OF THE WAR

The evacuation of patients from the casualty clearing
stations at Gezaincourt and from No. 3 (Canadian) Station-
ary Hospital was controlled by Lieut. -Colonel Fitzgerald
of No. 45 CCS. The former were receiving chiefly those
wounded which were being sent back by the light railway
from Acheux, and were thus connected more with the opera-
tions in the northern sector of the Third Army ; the
latter was receiving casualties that were being cleared
from the field ambulances of the southern sectors by road.
Lieut. -Colonel Fitzgerald's chief concern was to relieve the
congestion at the Citadel. The entraining station at Doullens
was more than a mile from the Citadel, and a large number
of ambulance cars was necessary for bringing the wounded
from the hospital to the trains. Consequently it happened
that in an emergency some of the cars bringing wounded
back from the field ambulances were requisitioned by Colonel
Fitzgerald to assist in this work ; this lead to great delay
in their return to the field ambulances and consequent diffi-
culty in getting wounded away from the advanced dressing
stations before the enemy's advance. At Gezaincourt, on
the other hand, entraining was easy, as there was an ambulance
train siding at the site of the casualty clearing stations. It
was, however, some three miles distant from the Citadel,
and therefore of less value as an entraining centre for No. 3
(Canadian) Stationary Hospital.

The casualty clearing stations in the northern sector of the
Third Army did not suffer to the same extent as those further
south. No. 20 CCS. remained at Boisleux-au-Mont while
No. 43 CCS., which had been withdrawn from that advanced
position early in March, was being established at Bac du Sud.
It was, however, being dismantled and tentage was being
pitched for it at Bac du Sud before the German attack on
the 21st March. In fact it was practically closed for the
admission of casualties. All wounded arriving at Boisleux-
au-Mont were sent on to Bac du Sud. The nursing sisters,
with the exception of three, had been sent away on the 17th
March. After the attack the work of dismantling and remov-
ing the huts of No. 20 CCS. was continued until the 24th
March, when the unit finally moved to Bac du Sud, having
salved everything except two Adrian huts, outbuildings and
a Thresh disinfector. It did not, however, open for work
at Bac du Sud, but was moved by train to Vignacourt, where
it commenced to open under canvas on the 28th March. It
opened there on the 1st April and came under the Fourth
Army command on the 8th April. ■

GERMAN OFFENSIVE AGAINST THIRD ARMY 241

Consequently all the work of evacuating the wounded from
the sector immediately south of Arras fell upon No. 43 CCS.
at Bac du Sud. Seven surgical teams were at work there and
the tentage and other accommodation of No. 20 CCS. was
utilized by it. It was not till 4 p.m. of the 21st March that
wounded began to arrive in a constant stream of about forty
hourly, a number which had increased to about sixty hourly
by the 25th March. On that day the advance of the enemy
placed Bac du Sud in a position of danger, and during the
night of the 25th/26th March the D.M.S. ordered the sisters
to be sent away, No. 20 CCS. to pack up and move by rail,
and No. 43 CCS. to have as much as possible of the equipment
not in use ready at the railway siding. Twenty trucks had been
requisitioned for the purpose of removing the equipment by
rail. The wounded continued to stream in, however, and at
9 a.m. of the 26th 1,015 were in the unit, 2,455 having been
evacuated during the previous twenty-four hours. During
the rest of the day the unit was actively engaged in preparing
for a move and in sending the wounded away by road and rail.
All patients were cleared by 5.45 p.m. and by 4.15 a.m. of the
27th the twenty trucks had been loaded and moved off. Field
ambulances of the Vlth Corps divisions took over the site
immediately afterwards. The personnel of No. 43 CCS. was
sent by lorries to Frevent, where the train with the equipment
arrived at 7 p.m. No 43 CCS. was then reopened at Frevent
on the 1st April. The work of the unit at Bac du Sud was
thus exceptionally severe. Between the 21st and 26th March
6,134 casualties were admitted. The number of major opera-
tions performed was 420.

The remaining group of casualty clearing stations in the Third
Army were Nos. 7, 8 and 19 at Agnez-les-Duisans. The work
there was not of an exceptional character and the casualty
clearing stations were affected by the German offensive to a
much less extent than the other casualty clearing stations of
the Army. It was considered advisable, however, to reduce
the number of units on this site. Nos. 7 and 19 C.C.Ss. were
closed, the former on the 26th March, and the latter on the
28th March. No. 7 had only opened for work at Agnez-les-
Duisans two days before the attack. It had arrived there from
Bracquemont (Noeux-les-Mines) on the 6th of March. After
closing at Agnez it was transferred to Ligny St. Flochel, about
four miles east of St. Pol, near the Arras road, where it detrained
on the 29th March and opened a few days later on the site of
the Third Army Trench Mortar School with accommodation

242 MEDICAL HISTORY OF THE WAR

for 700 to 1,000 in eighty marquees, some huts, and buildings.

No. 19 CCS. left Agnez on the 29th March for Frevent,
where it reopened near No. 43 CCS. on the 15th April. But
on the 28th March a detachment had been sent to open a
casualty clearing station for receiving walking wounded at
Avesnes-le-Comte. This was converted into an advanced
operating centre on the 2nd April. The detachment remained
there until the 12th April, when it was withdrawn.

No. 8 CCS. remained at Agnez-les-Duisans. Its heaviest
day's work was during the twenty-four hours ending 9 a.m.
on the 29th March, when 1,545 wounded were admitted from
the attack along the Scarpe Valley. The unit was transferred
to the First Army on the 7th April, when the XVI I th Corps
sector was transferred to that Army. It remained at Agnez
till the 17th April, when, in consequence of the renewal of the
German offensive, Agnez-les-Duisans was abandoned and the
casualty clearing station moved back to Wavrans.

No. 3 (Canadian) CCS. was transferred from Remy Siding
to Frevent on the 26th March. It opened near No. 6 Stationary
Hospital in fields where Nos. 19 and 43 C.C.Ss. were also being
established after their withdrawal from Bac du Sud and Agnez-
les-Duisans.

The successive moves of the Third Army casualty clearing
stations as described above are shown on the sketch map.
It will be seen that by the end of March they were all,
except No. 7, west of, or on, the main railway line from St.
Pol to Amiens.

Although most of the casualty clearing stations had lost
some of their equipment, enough had been salved to enable
all but one, No. 48, to carry on. No. 48 was sent to Boulogne
by order of the D.G.M.S. to refit, its personnel being employed
in No. 3 (Canadian) Stationary Hospital at Doullens till it was
again ready to go to an Army. Although all the equipment
of No. 45 CCS. had been salved it had been divided amongst
the casualty clearing stations at Gezaincourt, and it too was
sent to Boulogne to be refitted.

On the 6th April the XVI I th Corps area was taken over
by the First Army and with it went the casualty clearing
stations at Agnez-les-Duisans and Ligny St. Flochel. On the
following day the Fourth Army took over the Vllth Corps
area, with No. 4 and the Lucknow C.C.Ss. at Pont Remy, and
No. 20 at Vignacourt. Later on No. 49 at St. Riquier also came
into the Fourth Army area.

The headquarters of the Third Army then moved to Hesdin,

GERMAN OFFENSIVE AGAINST THIRD ARMY 243

and No. 59 CCS. there was transferred to it from G.H.Q. A
large amount of surplus stores salved from medical units during
the retreat had accumulated at Doullens and these were trans-
ferred to No. 59 CCS.

The D.M.S. of the Third Army then arranged for No. 45
CCS. to be placed at Auchy-les-Hesdin in the Ternoise Valley,
and No. 48, now re-equipped, at Fillievres in the Canche
Valley, half-way between Hesdin and Frevent. Ligny-sur-
Canche in the same valley and Wavans in the valley of the
Authie between Doullens and Auxi-le-Chateau were also sub-
sequently selected as sites for Third Army casualty clearing
stations. No. 21 CCS., from Auxi-le-Chateau, was moved
to Wavans ; No. 3 (Canadian) from Frevent to Ligny-sur-
Canche. No. 38 CCS., which had been sent to Vignacourt,
was moved to Fienvillers, on the Doullens-Domart road, when
Vignacourt came into the Fourth Army area.

Medical Stores and Laboratories,
None of the advanced depots of medical stores or mobile
laboratories of the Third Army lost their equipment. No. 15
Advanced Depot was at Frevent throughout, No. 16 had
moved from Boisleux-au-Mont to Bac du Sud before the attack
and was transferred from there to Auxi-le-Chateau and then
to Wavans with No. 21 CCS. ; No. 34 was moved from
Albert, on the 23rd March, to Beauval and thence, in the
middle of April, to Gezaincourt. Savy, where No. 33 was
established, came into the First Army area on the 6th April
and the unit was transferred then to that Army.

Medical Services of Corps.

The medical services of the divisions and corps in the Third
Army during the German attack worked methodically through-
out, falling back from point to point without confusion and
according to plan.

The Vth Corps. — No attack developed on the sector held
by the Vth Corps on the 21st March, but it was severely
shelled with gas shells on the Trescault front from the 12th
to 14th March, as many as 2,131 gassed patients being admitted
to its medical units during that period. The corps, however,
had to retire on the 21st March in conformity with the retire-
ment of the Vllth Corps on its right and the IVth on its left.
On the 22nd March one of its divisions, the 17th, was heavily
attacked at Hermies, and although the enemy was repulsed,
the corps was again obliged to retire in conformity with the

244

MEDICAL HISTORY OF THE WAR

retirement of the corps on its flanks. The casualties admitted
to the field ambulances were comparatively few as many were
captured by the enemy in the forward areas. None admitted
to the field ambulances, however, were abandoned. The
medical units fell back from day to day until, on the 25th March,
the dressing stations were all west of the Ancre ; and on the 27th
March a corps main dressing station was formed at Clairfaye
near Acheux. All the walking wounded were collected at
Acheux and sent to Gezaincourt by the light railway.

The wounded collected by the divisional field ambulances
of the corps numbered 4,991 between the 21st and 31st March,
the greatest number on one day being 971 on the 23rd March.

The IV th Corps. — The IVth Corps advanced dressing stations
at Doignies, Beetroot factory, and Vaulx were rapidly cut off
on the attack of 21st March, and many of the wounded of the
51st Division were captured at Beetroot factory advanced
dressing station. Wounded came in very slowly, as few could
be collected owing to the enemy's rapid advance ; but during
the first twenty-four hours approximately 85 officers and
1,619 other ranks had been admitted to field ambulances.
The main dressing stations were at Beugny and Favreuil, and
to these points the advanced dressing stations withdrew. A
corps main dressing station and collecting station for walking
wounded were opened at a place called Loch's Camp about
one and a half miles from Bapaume on the Bapaume-Cambrai
road.

The casualties amongst the R.A.M.C. were heavy : —

Killed.

Wounded.

Missing.

Total.

Off.

O.R.

Off.

O.R.

Off.

O.R.

Off.

O.R.

6th Division
25th Division
51st Division

]
?

4
2

2
3

7
28

* The 51st Division had about 100 other ranks R.A.M.C.
or captured.

killed, wounded

The field ambulances retired day by day on Grevillers and
thence to the west of the Ancre practically to the positions
occupied by field ambulances of the VHIth Corps during the
battles of the Somme in 1916.

The Vlth Corps. — The Vlth Corps held the sector south of
Arras. Main dressing stations were open at Ervillers, Hamelin-
court and Ficheux, with advanced dressing stations at Noreuil

GERMAN OFFENSIVE AGAINST THIRD ARMY 245

and Ecoust for the 59th and 34th Divisions, which were the
two in the line at the time of the attack. A walking wounded
collecting station was at Mory. The advanced dressing stations
at Noreuil and Ecoust were captured on the 21st March ;
on the 22nd March the main dressing station at Ervillers, and
on the 23rd March the main dressing stations at Ficheux and
Hamelincourt were withdrawn. Main dressing stations were
then opened at Blair ville and Ayette.

During the first forty-eight hours of the battle 70 officers
and 1,589 other ranks passed through the dressing stations ;
11 officers and 146 other ranks of the R.A.M.C. were missing
in the 59th Division alone, and in the 34th Division two
R.A.M.C. officers and four other ranks were killed, one officer
and six other ranks wounded, and two officers and twelve other
ranks missing.

On the 24th March four divisions, the 40th, 31st, Guards, and
3rd, were in the Vlth Corps front line. On the 27th March
a corps main dressing station was formed at Bac du Sud on the
site of No. 43 C.C.S., with advanced dressing stations at Wailly,
Blairville, and Monchy-au-Bois. Walking wounded went to a
field ambulance at Gouy and thence to the detachment of No.
19 CCS. at Avesnes-le-Comte. The position of the corps
medical services was then very much the same as those of
the Vllth Corps during the battle of Arras in 1917. The
2nd Canadian Division joined the corps on the 30th March and
the line was then held by it and the Guards and 31st Divisions.

The XV Ilth Corps.— The XVIIth Corps, which held the
Scarpe Valley sector, was not attacked till the 28th March.
As its line was not withdrawn, there was practically no dis-
turbance of its medical arrangements. The number of wounded
collected during the twenty-four hours, from 6 a.m. 28th to
6 a.m. 29th March, was 42 officers and 1,270 other ranks. On
subsequent days the casualties were comparatively few.

The Medical Services of Divisions.

The experiences of the medical services of the divisions in
the Third Army were similar in many respects to those in the
Fifth Army. It was difficult in some instances to maintain
constant communication between field ambulance advanced
dressing stations and regimental aid posts, chiefly owing to the
casualties amongst regimental medical officers. Liaison between
brigades and field ambulances had in such instances been de-
fective, especially in keeping the A.D.M.S. informed of the
casualties amongst battalion medical officers.

246 MEDICAL HISTORY OF THE WAR

But the chief difficulties were in clearing the wounded
back from the advanced dressing stations. The heavy shelling
of the roads, and the exceptional congestion of traffic on them
made the task extremely arduous. Ambulance cars were
held up with wounded in them for long periods, and, further,
many of the motor ambulance convoy cars were unable to
assist in evacuating the field ambulances, as they had to be
employed in clearing the casualty clearing stations when it
was impossible to clear them by ambulance trains. Conse-
quently, although reserve convoys under the D.G.M.S. and
D.M.S., L. of C. control were sent up to help in clearing the
casualty clearing stations, the field ambulance cars had
frequently to help the corps convoys in clearing the main
dressing stations to Edgehill and Doullens, and were often
away for many hours. For instance, as mentioned above, the
ambulance cars of one field ambulance were held up at
Doullens to assist in moving patients from No. 3 (Canadian)
Stationary Hospital to the entraining station. In other cases
field ambulance cars on arriving at the casualty clearing
station site found it abandoned and had to continue the
journey to Doullens ; or on their way back to their unit they
might be stopped to pick up seriously wounded and go back
with them to a casualty clearing station.

The result of this was that severely wounded collected in
advanced dressing stations could not be got away before the
enemy captured the position ; but all wounded admitted to
a main dressing station were saved from capture.

A.Ds.M.S. of divisions and Os.C. of field ambulances strongly
emphasize the importance of establishing main dressing stations
of divisions or corps at fixed points during a retreat ; and on
field ambulances retaining their own ambulance transport
solely for bringing wounded back from the front area and
advanced dressing stations to these main dressing stations
and no further. Had this been done probably all the wounded
collected would have got back.

Medical Arrangements for French Sick and Wounded.

French troops were operating in April in the areas of the
Fourth and Third Armies and arrangements were then made
by the D. D.G.M.S. in consultation with the D.M.S. of the
French Xth Army, Med. Inspecteur General Simonin, for
French sick and wounded to be received into the casualty clear-
ing stations of the Third and Fourth Armies and cleared from
there either by a French ambulance train being brought up,

GERMAN OFFENSIVE AGAINST THIRD ARMY 247

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10134

248 MEDICAL HISTORY OF THE WAR

to the British CCS. should the number of French patients
justify this, or by French ambulance cars bringing them
to a French hospital or to the entraining station of French
ambulance trains. The French became responsible for thus
clearing their casualties from the British casualty clearing
stations, but if they were unable to bring up trains or
cars it was arranged to evacuate French sick and wounded
along with the British casualties to the British bases where
there were also French hospitals, and to have them transferred
to these hospitals direct from the ambulance trains. These
arrangements worked smoothly in the Third and Fourth Army
areas.

Casualties during the German Offensive on the Somme.

The records of the number of casualties admitted to field
ambulances and casualty clearing stations of the Third Army
are fairly complete ; but the Fifth Army units were unable
to maintain their records or had to abandon them. Such
records as are obtainable from the diaries of the medical
units from the 21st March to 8th April are shown in the table
on the preceding page.

CHAPTER XV.

THE GERMAN OFFENSIVE ON THE LYS IN 1918.

THE enemy's offensive against Amiens and Arras had
scarcely been brought to a standstill before he launched
a second attack, this time against the First and Second Army
front from the Bethune-La Bassee Canal to the Ypres salient.
The offensive commenced with a heavy bombardment
along the front from Lens to Armentieres, more especially of
gas shells on the right and left of the British positions, and on
the 9th April a strong attack was made on the sector held by
the 2nd Portuguese Division in the Neuve Chapelle-Laventie
area. The Portuguese had the 55th (British) Division of the
1st Corps on their right on the La Bassee front and the 40th
(British) Division of the XI th Corps on their left on the Bois
Grenier front. The 51st and 50th Divisions were behind in
support. The Portuguese Division was overwhelmed, and
the gap made by its retirement was held for a time near Vieille
Chapelle by 1st King Edward's Horse and the 11th Cyclist
Battalion until the 51st and 50th Divisions came into action.
The 40th Division was forced to retire across the Lys, while
the 55th held its ground at Festubert. A line was then held
on the night of 9th April east of the canalized River Lawe
between the La Bassee Canal, north of Bethune, and the
Lys Canal at Estaires. The attack was renewed on the 10th
April and the enemy pressed back the British line by the even-
ing to the west of the Lawe at Vieille Chapelle, through Lestrem
to between Estaires and Merville, and along the Armentieres-
Bailleul railway to the north of Steenwerck. The attack
was also pushed against the 25th and 19th Divisions of the
Second Army and the line held by them was driven back
to Ploegsteert, Messines and Wytschaete. The 9th Division
on the left, however, cleared the position and the Messines
ridge was held. In the meantime the 34tb Division in
Armentieres, being thus exposed on both flanks, though not
attacked except by previous gas shelling, was withdrawn
to the left bank of the Lys.

(10134) i »

250 MEDICAL HISTORY OF THE WAR

On the 11th April the pressure of the enemy continued
and Merville was captured. Much fighting took place on the
Messines ridge, and the troops which were holding the Ploeg-
steert sector were obliged to fall back to positions east of
Neuve Eglise and Wulverghem, leaving Hill 63 and Messines
positions in the hands of the enemy. Reinforcements were
now being brought up from the southern sectors of the First
Army and the neighbourhood of Arras.

There was still desperate fighting on the 12th April in the
area between Merville and Bethune and in the area between
Merville and Bailleul to the east of the Forest of Nieppe. In
the former area the enemy broke through the British line
and formed a salient between Hinges and St. Venant, reaching
its farthest point half-way between Mt.Bernenchori and Robecq.
In the latter area the line was forced back to the immediate
south of Bailleul and to between Oultersteene and Merris,
but the enemy advance towards Hazebrouck was definitely
checked between Meteren and the Forest of Nieppe.

Fighting continued north of this line on the following days
around Neuve Eglise and Wytschaete, and on the 15th April
Bailleul came into the enemy's possession. The British
line was then straightened from Meteren to Dranoutre, and
shortened in the Ypres salient by gradual withdrawal from
the Passchendaele ridge. French forces forming a detachment
of the Armee du Nord were moved in support of the British.
On the 17th April attacks were made on Kemmel Hill and
along the whole front from Givenchy to west of Merville,
but were repulsed. French troops then gradually relieved
the British and by the 21st April held the whole of the front
from St. Jans Cappel to Kemmel Hill with four divisions.

Fighting then died down till the 25th April when a strong
attack was made on the French and British line from Bailleul
to the Ypres-Comines Canal. The 9th Division with part
of the 49th and 21st Divisions were on the French left in the
neighbourhood of Wytschaete and the 1st Australian on the
French right south-west of Bailleul. The main attack was on
the Kemmel Hill and on the 9th Division positions. Kemmel
Hill was captured from the French, but after counter-attacks
by the 9th, 21st, 25th, 49th, 30th and 39th Divisions in con-
junction with the French the line remained otherwise unbroken.
Owing to the occupation of Kemmel Hill by the enemy,
however, the line of the Ypres salient was withdrawn to east
of Pilckem and St. Jean, and thence to Zillebeke Lake and
the west of Voormezeele.

M OVE M E NT OF CASUALTY CLEARING STATIONS

OF FIRST & SEC OND ARMIES DURING THE GERMAN OFFENSIVE ON THE LYS,I9I8

Berques

GERMAN OFFENSIVE ON THE LYS, 1918 251

With another determined attack on the 29th April, which
was repulsed, the German offensive of 1918 on the British
front ended.

In the meantime the 8th, 21st, 50th and 25th Divisions
were being transferred under the IXth Corps command
to replace French divisions of the Sixth French Army
that were sent to support the British behind Amiens. The 8th,
21st and 50th Divisions were put into the line north-west of
Rheims, and, with the 25th Division, were involved in a
great German attack along the whole of the Aisne front to
Rheims on the 27th May. The allied line was broken and the
enemy reached the Marne, where on the 6th June his advance
was checked.

On the following day " a fresh battle broke out on the French
front between Noyon and Montdidier,"* but without serious
effect on the allied line. It was then, however, necessary to
withdraw the French divisions from the British area in Flanders
to the French front south of the Somme, and four more British
divisions were placed at the disposal of Marshal Foch behind
the junction of the French and British in front of Amiens.
The XXIInd Corps with the 51st, 62nd, 15th and 34th Divisions
was accordingly sent to positions behind the junction of
the French and British on the Amiens front. The result of
these operations on the British medical services is described
later on.

The Medical Situation at the time of the Offensive.

With regard to the medical services during the offensive
on the Lys, the events on the Somme had given early warning
of the disadvantages and risks of retaining casualty clearing
stations in forward positions.

The experience of the ten days of the German offensive
against the Fifth and Third Armies had also shown how im-
portant it was for medical units to retain their mobility and
to be guided by the principles laid down in the Manual of
R.A.M.C. Training. This was impressed on the medical
services by the D.G.M.S. in the following memorandum issued
on the 2nd April to Ds.M.S. of Armies : —

" The experience of the last ten days of March demonstrates the para-
mount importance of medical units maintaining their mobility in the field.

" Trench warfare and the desire to carry on surgical work to the highest
degree of perfection have led casualty clearing stations to become large and
immobile units, pushed as far forward as possible, thus diminishing the
tactical importance of maintaining mobile main dressing stations at inter-
mediate positions.

* Sir Douglas Haig's despatches, p. 254.

252 MEDICAL HISTORY OF THE WAR

" The consequence of this has been that in certain areas casualty clearing
stations have had to abandon valuable equipment in retiring, that in some
instances no main dressing stations had been opened in their place for the
reception of wounded, and that the motor ambulance cars of the field ambu-
lances have been employed in carrying the wounded back to casualty clearing
stations to the new positions of the latter farther back.

" In consequence of the time lost in returning from these, the field ambulance
cars have not been able to arrive in time to remove lying-down cases collected
at the collecting posts by the bearer divisions, and many wounded unable to
walk have been abandoned.

" Much of this might have been avoided if the principle had been invariably
adhered to of working the motor ambulance transport of field ambulances
in collecting wounded from collecting posts to main dressing stations and no
farther.

" Your attention, therefore, is directed to the importance of arranging that
when casualty clearing stations are situated far back from the front line, as
they ought to be in the present military situation, intermediate main dressing
station positions, which can be moved rapidly in echelon backwards or for-
wards as required, shall be established by divisions or corps, and that the
motor ambulance transport of the field ambulances in the front area shall
be employed for bringing wounded back only to these main dressing station
points.

" The motor ambulance convoys are intended for the purpose of working
between main dressing stations and the casualty clearing stations and should
be employed for that purpose and not for general work in a pool with the
motor ambulance transport of the field ambulances.

" Should our front line in the course of pressure by the enemy be forced
back, the withdrawal of the main dressing stations will necessarily be in accord-
ance with the general situation, but they should be established at suitable
points in echelon during the withdrawal, so that there shall always be a point
to which the motor ambulance transport of the field ambulances can bring
their wounded without having to go farther back, and to which the motor
ambulance convoys can work without having to go farther forward."

In other respects the Director-General's arrangements
issued on 6th March held good. Motor ambulance cars and
surgical teams were diverted from the Third and Fifth to the
First and Second Armies, when the position of the former had
become stable and resources which had been at the disposal
of the D.G.M.S. during the Somme offensive were available
for the offensive on the Lys.

After the battle of Vimy Ridge in 1917 the D.M.S. of the First
Army had moved his casualty clearing stations to positions
much nearer the front line than had previously been considered
advisable. In September and October 1917 he had transferred
No. 30 from Aubigny and No. 57 from Aire to Anzin-St. Aubin,
in the Scarpe Valley, about three miles north-west of Arras
and about nine from the front line. In November and Decem-
ber he had established a group of three casualty clearing
stations, No. 6, No. 1 (Canadian) and No. 4 (Canadian), under
canvas and in huts in open ground near Ruitz, about seven
miles from the front line ; while another casualty clearing
station, No. 7, was still farther forward at Bracquemont,

GERMAN OFFENSIVE ON THE LYS, 1918 253

Noeux-les-Mines, only slightly more than four miles from
the front line. No. 33 C.C.S. at Bethune, and Nos. 51 and 54
at Merville were also within the danger zone, at distances of
five and seven miles respectively from the front line. No. 1
at Chocques was also within ten miles of the front line. With
the exception of Bethune, Noeux-les-Mines and St. Aubin,
which were frequently exposed to long range high explosive
shells, these units had been fairly free from hostile action.
But the positions were recognized to be unsuitable for a policy
of defence. No. 7 C.C.S. was consequently transferred from
Bracquemont on the 6th March to Agnez-les-Duisans, as
noted in the previous chapter ; and before the German offensive
of the 21st March had taken place, No. 57 was being moved
to Aubigny from St. Aubin. No. 33 had been moved from
Bethune towards the end of February to a site near Havers-
kerque ; so that the units remaining at Ruitz, St. Aubin,
Chocques and Merville only were within the danger zone on
the 21st March.

On the 23rd March, in consequence of the events in the
Fifth and Third Armies, the D.G.M.S. instructed the D.M.S.,
First Army, to move back his casualty clearing stations from
these places with the least possible delay to positions which
would enable evacuation by ambulance train to be carried
out from the railway line running through Lapugnoy, Pernes
and St. Pol. If the D.M.S., First Army, considered it essential
to retain within the more forward zone means of dealing
with urgent surgical cases, he was instructed to form an ad-
vanced operating centre with personnel and material capable
of being moved by the lorries belonging to the casualty
clearing stations. In fact, all casualty clearing stations had
been warned by the D.G.M.S. as early as the 3rd March
to be in possession of their mobilization equipment of marquees
in the event of their being required to move at short notice.
Many of these marquees had been distributed to field ambulances
for various purposes, especially those of casualty clearing
stations which had been accommodated in buildings and huts.

Consequent on these instructions, the D.M.S. of the First
Army immediately moved No. 30 from St. Aubin to Wavrans
on the St. Pol-Anvin railway line, No. 54 from Merville to
Haverskerque alongside No. 33, and No. 4 Canadian from
Ruitz to Pernes on the St. Pol-Lapugnoy line. These moves
had been completed before the attack of the 9th April. No. 18
was also moved as a precautionary measure from Lapugnoy
to Lillers at the beginning of April. The section of the Lucknow

254

MEDICAL HISTORY OF THE WAR

CCS. attached to No. 22 at Bruay for Indian drivers was
not, however, moved back at that time.

The situation of casualty clearing stations of the First
Army on the 9th April was consequently as follows : —

Casualty Clearing Station.

Locality.

Distance
from Front.

Forward Areas —

No. 1

Chocques

8 miles.

No. 6

Ruitz

7 miles.

No. 22

Bruay

}

9 „

Lucknow (detachment)

No. 51

Merville
Intermediate Areas —

7 „

No. 23

Lozinghem

11 „

No. 42

Aubigny

11 „

No. 57

No. 58

Lillers

)

12 „

No. 18

No. 33

Haverskerque

11 „

No. 54

„

Back Areas —

No. 30

Wavrans

18 „

No. 4 (Canadian)

Pernes

}

15 „

No. 1 (Canadian)

No. 7

Ligny St. Flochel. .

18 „

There was also a Portuguese CCS. at St. Venant, and
No. 8 CCS. at Agnez-les-Duisans was practically taken
over by the First Army, although not actually transferred
for some days later.

The casualty clearing stations of the Second Army were
also being moved from forward positions. The most advanced
of the casualty clearing stations was No. 2 (Australian) at Trois
Arbres, within four or five miles of the front line. It was
moved to Oultersteene on 15th March. It then formed
one of a group of casualty clearing stations there with
No. 2 and No. 1 (Australian), but these casualty clearing
stations, and No. 53 at Bailleul, Nos. 4 and 47 at Dozinghem,
were also in a dangerously forward area of six to eight miles
from the front line. The Bailleul and Dozinghem positions
were abandoned by the transfer of No. 47 CCS. to the Fifth
Army on the 7th March, No. 53 on the 8th March, and No. 4
on the 25th March. The casualty clearing station group at
Oultersteene was then transferred during the first week in April
to a siding on the railway line north-west of Hazebrouck

GERMAN OFFENSIVE ON THE LYS, 1918 255

called " Ana Jana Siding," one of the group, No. 2, being sent
still farther back to Ebblinghem, between Hazebrouck and
Arques, where No. 15 had already been established after
the battles of Ypres in 1917.

There were, however, other groups of casualty clearing
stations within the danger zone when the offensive of 9th
April was launched, and the D.M.S. of the Second Army had
been taking steps to reduce the number of casualty
clearing stations in the forward areas. No. 3 (Canadian)
CCS. had been transferred from Remy Siding to the Third
Army on the 25th March, and No. 17 to Ana Jana Siding
on the 2nd April, leaving only No. 10 and No. 2 (Canadian)
CCS. at Remy Siding. No. 12 CCS. was transferred from
Mendinghem to the Fifth Army on 30th March, and only
No. 64 remained at that place. No. 44 CCS. was moved
from Nine Elms to Arneke on the 5th April, No. 3 (Australian)
only remaining at Nine Elms. Of the two at Bandaghem,
No. 63 CCS. was transferred to Arneke on the 3rd April,
leaving No. 62 CCS. there.

The position of casualty clearing stations in the Second
Army in anticipation of the offensive was consequently
as follows : —

Casualty Clearing Station.

Locality.

Approx.

Distance

from Front.

Forward Area — ■

No. 10

No. 2 (Canadian)

No. 11

Remy Siding
Godewaersvelde . .

> 8 miles.
9 „

No. 64

Mendinghem

8 „

No. 36

No. 3 (Australian)

No. 62

Roosbiugge
Nine Elms
Bandaghem

Back Area —

9 „

8 „

9 „

No. 13

Arneke

No. 44

„

V20 „

No. 63

„

No. 15

No. 2

Ebblinghem

\ 19 „

No. 17

Ana Jana . .

]

No. 1 (Australian)
No. 2

> 15 „

The Medical Services of the First Army during the Offensive.

The Casualty Clearing Stations. — Immediately after the

German attack on the 9th April, the casualty clearing

256 MEDICAL HISTORY OF THE WAR

stations of the First Army at Ruitz, Bruay, Chocques, Lillers,
Merville and Haverskerque were in danger ; No. 6 CCS.
was withdrawn from Ruitz to Pernes ; No. 22 from Bruay to
Lozinghem ; No. 51 from Merville and Nos. 33 and 54 from
Haverskerque to Aire by the 12th April. The two casualty
clearing stations at Lillers, No. 18, which had just come there,
and No. 58, were rapidly withdrawn, the former to Arques
and later on to Malassise, and the latter to Longuenesse in
the St. Omer area. No. 1 was withdrawn from Chocques to
Arques on the 10th April. These three casualty clearing
stations remained, however, parked for the time being pending
a decision regarding the move of Lines of Communication
medical units from St. Omer and Arques.

The Portuguese casualty clearing stations at Merville and
St. Venant, owing to the attack on the Portuguese front and
the reorganization of the Portuguese divisions, were with-
drawn and arrangements had to be made by the D.M.S. of
the First Army for their wounded being taken over by British
medical units.

The situation, therefore, in the First Army during the first
week of the German offensive on the Lys was that all of its
casualty clearing stations, except Nos. 22 and 23, which were
at Lozinghem, Nos. 42 and 57 at Aubigny, and No. 8 and No. 7,
which were at the disposal of the First Army, or had been
taken over by it from the Third Army at Agnez-les-Duisans
and Ligny St. Flochel, were back in the neighbourhood of St.
Omer, Aire, Pernes and Wavrans. No. 8, however, was moved
from Agnez-les-Duisans to Wavrans on the 17th April.

The D.M.S. of the First Army had been under the impression
that his casualty clearing stations could be established at
St. Omer, but, when it was decided that St. Omer should come
into the Second Army area, he withdrew No. 1 from Arques
to Elnes the nearest point to St. Omer in the First Army area.
No. 18 at Arques and No. 58 at Longuenesse were then trans-
ferred to the Second Army. Subsequently, at the beginning
of July, Elnes passed into the Fifth Army area. No. 8 CCS.
and No. 1 CCS. then took one another's place at Elnes and
Wavrans respectively, owing to the desire of the First Army
D.M.S. to retain No. 1 CCS. in his area.

This situation of the casualty clearing stations remained
unchanged in the First Army during April, the casualties
being evacuated to the casualty clearing stations in these
localities through main dressing stations of corps and divisions.
Neither personnel nor much of the equipment of casualty

GERMAN OFFENSIVE ON THE LYS, 1918 257

clearing stations had been lost owing to the early steps taken
to withdraw them from forward positions. But the two
casualty clearing stations at Lozinghem, Nos. 22 and 23,
remained within six or seven miles of the farthest point to
which the Germans advanced in the direction of Lillers.
Lozinghem was then exposed to artillery fire and both the
casualty clearing stations there were shelled on the 9th May.
They were then withdrawn to Pernes and Anvin respectively.

Until the end of the German offensive and the commencement
of the allied advance, the First Army evacuation centres were
thus concentrated at Aire, Pernes, Wavrans, Anvin, Aubigny
and Ligny St. Flochel, to which No. 33 was moved from
Aire on the 9th May. In addition, the First Army had two
stationary hospitals, No. 39 at Fort Gassion, Aire, and No. 12
at St. Pol.

The situation of casualty clearing stations of the First
Army was therefore as follows at the end of the German
offensive : —

Aubigny . . . . . . Nos. 42 and 47.

Wavrans . . . . . . Nos. 30 and 1 (replaced at Elnes by No. 8).

Pernes . . . . . . No. 4 (Canadian), 1 (Canadian), No. 6 and

No. 22.

Ligny St. Flochel . . . . Nos. 7 and 33 (from Aire).

Aire . . . . . . . . Nos. 51 and 54.

Anvin Nos. 23, 2 and 15 (the two latter C.C.Ss,

had been transferred from the Second
Army at the end of June).

Most of the new sites selected, such as those at Wavrans,
Pernes and Anvin, were at some distance from the railway
line, owing to the frequent shelling of and air raids on railway
stations and junctions.

The D.M.S. of the First Army had delegated a part of the
administration of his casualty clearing stations to the D.Ds.M.S.
of Corps in whose area they were situated, as by so doing he
considered that the casualty clearing stations would have
more ready assistance from the corps staff in connexion
with engineer services and with the control of wastage. This
delegation of control or modified administration was not
favoured by the D.G.M.S. at G.H.Q. and was not officially
recognized, the main objections being that the control of
the casualty clearing stations became a dual control, being
partly by the D.M.S. of the Army and partly by the D.D.M.S.
of the corps, and that as the corps areas were constantly
changing, the O.Cs. of casualty clearing stations would con-
sequently be subjected to frequent changes in administrative

258 MEDICAL HISTORY OF THE WAR

control. Further, the work of casualty clearing stations was
not corps work. They received casualties from more than
one corps, so that the regulation of the admission to any
one casualty clearing station could not be vested in the D.D.M.S.
of any one corps but only in the D.M.S. of the Army. The
casualty clearing stations were essentially the links between
armies and the lines of communication, and it was therefore
extremely undesirable that their administration should pass
out of the hands of the Army Headquarters administration
into that of a tactical formation such as a corps. It was
not surprising, therefore, that this system of delegation of
control led to difficulties when the battle commenced and
the withdrawal of casualty clearing stations from their old
positions to positions farther back became necessary. In
fact, the diaries of the D.Ds.M.S. of corps in the First Army
during and after the offensive are filled to a great extent
with details of transfers of casualty clearing stations from
one corps to another and with discussions regarding the ad-
ministration of a casualty clearing station receiving only
the sick and wounded of one corps and in selecting sites
and other details for the establishment of casualty clearing
stations, matters which should properly have been settled
by the D.M.S. of the Army.

The Outbreak of Influenza. — During May and June influenza
of a mild type had been more or less prevalent in the First
Army, extensive outbreaks constantly occurring in various
units and manifestly of a very infectious character. It became
so marked that the D.M.S. of the Army issued a special
instruction on the subject on the 20th June, the chief object
of which was to retain the patients under treatment in the
army area and thus avoid their evacuation to the base. It
was not then considered to be of a serious nature, and the
patients returned to duty after a week or ten days. However,
on the 21st June, 3,000 beds at Etaples were placed at the
disposal of the First Army for these cases by the D.G.M.S.
The patients were to be sent there by special ambulance
trains, labelled " First Army P.U.O.* Special, Etaples." On
recovery they were to be returned direct to the First Army.
The first of these special trains left on the 22nd June from
Pernes, Aubigny, Ligny and Aire ; but difficulties at once
arose at the base because at the general hospitals there were no
pack stores for kits and equipment which accompanied the

* P.U.O. = "Pyrexia of uncertain origin."

GERMAN OFFENSIVE ON THE LYS, 1918 259

men in order to facilitate their return. The general hospitals
had not been organized to function as casualty clearing
stations or corps rest stations of armies, and this interference
with their functions was not advantageous, more especially
as the 3,000 beds were filled up in three days by these special
cases from the First Army, and were of no further use.

At the end of the active period of operations in June the
high rate of sickness from influenza materially affected the
situation, an attack, for example, which had been organized
by the 29th Division against La Becque on the 20th June,
having to be postponed on account of this.

The Medical Services of Corps. — The corps of the First
Army on the 9th April from right to left were the XVI I th,
XHIth, Canadian, 1st, Xlth and XVth. The Cavalry Corps
was moved into the First Army area just after the attack
was launched. The 1st, Xlth and XVth were the corps chiefly
concerned in the defence against the enemy attack, more
especially the two last.

The 1st Corps held the line south of the La Bassee Canal
to Lens, with the 46th and 11th Divisions, and with the 3rd
and 51st Divisions in reserve, but the number and positions of
divisions changed, and on the 14th April the 1st Corps had
four divisions in the line, the 11th, 1st, 3rd and 4th, with the
55th in corps reserve and the 46th Division in Army reserve.
The 55th Division had been transferred from the Xlth Corps
on the 12th April after it had held the enemy back at Festubert.
The 46th Division front was taken over on the 11th April
by the 3rd Canadian Division and went into Army reserve.

As the casualty clearing stations withdrew from the forward
positions main dressing stations of field ambulances took
their place. The main dressing station of the 11th Division,
for example, occupied the site of the casualty clearing stations
at Ruitz, where, however, on the 17th April' difncul ties arose
in consequence of two battalions marching to the site and
camping there. The D.D.M.S. at once objected to this and
the battalions were moved to another site.

On the 24th April the XHIth Corps took over the left
sector of the 1st Corps front along the La Bassee Canal line
from Bethune to Robecq and held it with the 3rd and 4th
Divisions. The 1st Corps front was then held by the 11th
Division on the right sector, the 1st Division in the Cambrin
sector, with the 55th Division along a sector from Givenchy
to Festubert, and the 46th Division from Festubert to the
Lawe river.

10134 U

260 MEDICAL HISTORY OF THE WAR

The medical services of the 1st Corps were not severely
engaged during May, beyond having to deal with the casualties
from gas shelling of the 46th Division on the 1st, 2nd and
22nd May. The situation was also unchanged in June, except
for gas shelling of the 55th Division on the 9th of the
month.

The Xlth Corps. — The Xlth Corps at the time of the attack

consisted of the 55th and 51st Divisions and the 2nd Portuguese

Division. The 55th Division had just handed over to the

1st Division of the 1st Corps the portion of its front south

of the La Bassee Canal. The 51st Division was in reserve.

The Portuguese were in the Neuve Chapelle sector with a

main dressing station at Zelobes. When the Portuguese

division was driven back a main dressing station was formed

by a field ambulance of the 51st Division. The 55th Division

at that time was fighting desperately at Festubert and holding

the enemy in check, and the remaining brigades of the 51st

Division were sent in support. Communication, however,

regarding the medical situation was cut off. The 61st Division

joined the Xlth Corps on the 11th April and the 50th Division

on the 12th April, with the 5th Division in a back area. The

line was then held by the 51st Division along the La Bassee

Canal to Robecq, the 61st Division from there to Merville, and

the 50th on its left, north of Merville.

Afterwards the medical situation in the Xlth Corps remained
more or less stabilized until the 28th June, when the 5th and
31st Divisions attacked towards La Becque, in the area between
Bailleul and Est aires. The number of wounded collected
then amounted to 867, including 52 Germans. A service
of barges on the Lys Canal between Aire and Nieppe Canal
had been arranged for these operations. Two barges for
twenty stretcher cases and two for eighty sitting cases had
been allotted to the 5th Division. The barges for sitting
cases plied between Houleron Ferry (near Tannay, half-way
between Haverskerque and Aire), where there was a walking
wounded collecting post, and Fort Gassion landing stage,
the journey there and back being calculated to take one and
a half hours only. The barges for the lying-down cases plied
between Nieppe Forest and the same landing stage, the
advanced dressing station being in the forest near Le Pare
and Forester's House. Motor ambulance cars brought the
wounded to these posts on the canal, and the barges brought
them to the landing stage for No. 39 Stationary Hospital
Fort Gassion.

GERMAN OFFENSIVE ON THE LYS, 1918 261

The Xlllth Corps. — The Xlllth Corps medical arrange-
ments were somewhat disorganized by the headquarters of
the corps moving to a back area and the 14th and 16th Divisions
of the corps being employed in preparing a defensive line
behind the First Army. Portuguese brigades were attached
to these divisions. The 14th and 16th Divisions had been
through the fighting with the Fifth Army and were being
reorganized. On the 24th April the corps went into the line
on the Aire-La Bassee Canal, taking over the 3rd and 4th

Scene on the Canal in the Forest of Nieppe.

Divisions in that area from the Lawe Canal north of Bethune
to the west of Robecq, where the Xlth Corps line commenced.
The situation on this front was fairly quiet and easy as regards
medical services.

The XVIIth Corps. — The XVIIth Corps, which came
under the First Army on the 6th April, was not involved in
the Lys offensive. As in other corps of the Army, mild influenza
was very prevalent in it, as many as 5,956 patients being
admitted for pyrexia of uncertain origin in the month of
June. Of these, 117 officers and 4,533 other ranks returned

(10134)

262

MEDICAL HISTORY OF THE WAR

to duty without being evacuated to the base. At the
beginning of the offensive of 9th April the divisions in the
XYIIth Corps were the 4th, 15th and 56th, and subsequently
the 15th, 51st and 56th.

The Canadian Corps. — The Canadian Corps medical services
in the sector between the XVIIth and 1st Corps also took
no active part in the battles of April. It was withdrawn
from the line in the beginning of May, when its front was
taken over by the XVIIIth Corps from the Fourth Army
with the 20th, 24th and 52nd Divisions, the last having only
recently arrived from Palestine.

The XVIIIth Corps front remained quiet during the sub-
sequent period of the offensive, with an average of about

Laventie Church, Estaires Front.

twenty, ten and five wounded daily in the three divisions
respectively during May.

The XV th Corps. — The XVth Corps was in the First Army
area on the left of the Portuguese and Xlth Corps on the 9th
April, with the 34th, 38th, 40th and 50th Divisions. The
40th and 34th Divisions were then in the line on the Laventie-
Armentieres front, but only the 40th Division was heavily
engaged, although both divisions suffered from mustard gas
shells, and help had to be asked for from the Second Army
to relieve the congestion in their field ambulances. Twenty
lorries were sent, and the D.M.S., First Army, also sent up
twenty-five cars to clear the dressing stations of the 40th
Division at Doulieu and Le Vervier. The lorries of the Second
Army cleared the wounded to its casualty clearing stations at
Ana Jana and Remy Siding. The XVth Corps, after the attack

GERMAN OFFENSIVE ON THE LYS, 1918 263

on the 9th April, was reinforced by the 29th and 31st Divisions
and it was then transferred to the Second Army on the 12th
April. The 50th Division on its right, however, was taken
over by the Xlth Corps of the First Army, and the 34th
Division on its left by the IXth Corps. On the 14th April
the 1st Australian Division came into the corps and took
over a considerable portion of j.ts front, the other divisions
in the corps being then the 29th and 31st. On the 16th
April French troops began to come up on the left of the
XVth Corps. The 9th Division joined the XV th Corps on
the 7th May.

Building used as advanced dressing station near Armentieres

No. 2 M.A.C. worked with the corps till the 18th May when
it was relieved by No. 14 M.A.C.

During the remaining period of the offensive the chief
casualties were from gas shells. The divisions suffered
severely from the influenza epidemic, as many as 1,000 being
admitted to the field ambulances on the 17th June. The
31st Division took part in the attack on La Becque by the
Xlth Corps on the 28th June, but this appears to have been
the only serious engagement on the XVth Corps front since
the first two or three days of the offensive.

The Medical Services of the Second Army during the Offensive.

The Casualty Clearing Stations. — The situation of the medical
services in the Second Army was complicated by the French
divisions, which occupied the area of some of its casualty

264 MEDICAL HISTORY OF THE WAR

clearing stations, more especially those at Arneke. The
position occupied by the casualty clearing stations at Ah]
Jana Siding was also disturbed by the advance of the enem\l
towards Hazebrouck. Consequently the three casualty!
clearing stations there, No. 17, No. 1 (Australian) and No. 2
(Australian), were moved on the 13th April to Blendecques,
just south of St. Omer, although they had only opened at
Ana Jana a week or ten days earlier. No. 11 CCS. from
Godewaersvelde joined them at Blendecques at the same
time. St. Omer and its vicinity thus became the locality
at which most of the casualty clearing stations of the Second
Army were being concentrated. No. 11 was transferred
from Blendecques to Moulle on the Calais road and No. 17
to Arques Chateau on the Aire road. No. 18 was at Malassise,
between St. Omer and Blendecques, and No. 58 at Longuenesse
just outside St. Omer. Both these had been withdrawn to
St. Omer by the D.M.S., First Army, from Lapugnoy and
Lillers, and together with No. 17 at Arques came under the
Second Army when the latter occupied the St. Omer area.
No. 1 CCS. was also at Arques from the 13th April to 9th
May, but was moved into the First Army area at Elnes as
already noted.

But in addition to the positions around St. Omer, casualty
clearing stations were opened for the Second Army in the
area between St. Omer and Bergues in the direction of
Dunkerque, No. 3 (Australian) from Nine Elms and No. 2
(Canadian) from Remy Siding were moved back to Esquelbecq
in the middle of April, and No. 36 from Roosbrugge, No. 62
from Bandaghem, and No. 64 from Mendinghem to Watten
at the end of the month.

When divisions of the French Armee du Nord occupied
the front between St. Jans Cappel and Kemmel, the casualty
clearing stations at Arneke were in the French Area, but, as
the French had then no corresponding units of their own to
which they could clear their field ambulances, the four casualty
clearing stations there, Nos. 13, 44, 63 and 10, were receiving
most of the French as well as British sick and wounded.

A similar situation, as already noted, existed in connexion
with French divisions with the Third and Fourth Armies. But
the arrangements made with the French D.M.S. in connexion
with the latter were not accepted by the D.M.S. of the French
Armee du Nord. He was insistent on French personnel
taking over British casualty clearing stations with their
stores and equipment until a French Hopital d'Evacuation

GERMAN OFFENSIVE ON THE LYS, 1918 265

ould be established. This led to difficulties, because the
:asualty clearing stations were required for the British as
well as for the French. It was consequently arranged to
hand over the whole of No. 63 and No. 13 C.C.Ss. to French
personnel, leaving only the Officer Commanding, the quarter-
master and a few other ranks R.A.M.C. in charge of the equip-
ment. Difficulties also arose regarding the running of
ambulance trains to Arneke, as both British and French had
to be evacuated. British ambulance trains were only allowed
to run there when convenient to the French authorities and
after consultation with them. This situation was rendered
more complicated by the fact that, owing to congestion of
the railheads in the northern areas of the Second Army,
British ambulance trains could not be brought up to Esquelbecq
at the beginning of May, and the patients in the casualty
clearing stations there had to be brought to Arneke to entrain.
A further complication occurred in connexion with the British
field stretchers which were being used by the French. These
stretchers did not fit into the French ambulance transport
and some inches of the handles of many of them were cut off
to enable them to be used on the French cars, thus rendering
them useless for interchanging with stretchers brought back
in British ambulance transport.

On the 30th April a conference was consequently held with
the D.Q.M.G., a French representative of General Foch, the
British liaison officer of the French Corps H.Q. in the Second
Army area, and the D.D.G.M.S., with regard to handing over
British casualty clearing stations to the French. It was
arranged that the number of British sick and wounded coming
into Arneke should be reduced and that only two ambulance
trains should be sent there daily for the British and four for
the French. The French authorities represented that Arneke
was in the centre of their area, and that the railway facilities
were not sufficient to allow of a large number of casualty clearing
stations remaining there.

The difficult situation was just workable. It was relieved
when the XXIInd Corps, whose sick and wounded were being
evacuated to the casualty clearing stations in Arneke, was
withdrawn from the line on the left of the French divisions.
Nos. 44 and 10 C.C.Ss. were then closed ; the former being
transferred to Bergues on the 9th and the latter to Quaedypre
on the 14th May, leaving Nos. 63 and 13 with the French
until June, when the former was moved on the 9th of the month
to Watten and the latter on the 14th to Holque.

266 MEDICAL HISTORY OF THE WAR

The medical services in the St. Omer and Blendecques area,
which had been a district of the lines of communication under
the administration of an A.D.M.S., were transferred to the
administration of the D.M.S., Second Army, at the end of
April, the A D.M.S. continuing under him to administer the
area as before. The general hospitals had been withdrawn
from St. Omer and its vicinity, namely Nos. 7, 58 and 59,
and only two stationary hospitals, Nos. 10 and 4, the latter
at Arques, and a voluntary hospital, No. 9B.R.C.S. (Millicent,
Duchess of Sutherland's), together with four casualty clearing
stations, No. 18 at Malassise, No. 58 at Longuenesse, No. 11
at Moulle, and No. 17 at Arques, remained under this adminis-
tration. They served as special hospitals for gassed, N.Y.D.N.,
infectious, venereal and Chinese labour patients. A voluntary
convoy of thirty cars of the First Aid Nursing Yeomanry
(F.A.N.Y.) was at the disposal of the A.D.M.S., St. Omer.

The medical situation in the Second Army then was that
two corps on the left, the XXIInd and Ilnd, were sending
their wounded to Esquelbecq casualty clearing stations ;
while Nos. 2 and 15 C.C.Ss. at Ebblinghem were receiving
wounded from the XV th Corps on the right, and the two
casualty clearing stations at Blendecques the walking wounded,
who were being brought back from the main dressing stations
by temporary ambulance trains. No. 18 CCS. at Malassise
was receiving infectious cases, and No. 11 at Moulle Chinese
sick. Three casualty clearing stations, Nos. 36, 62 and 64,
were opening at Wat ten ; and Nos. 44 and 10 were being
transferred from Arneke to the neighbourhood of Bergues.
The New Zealand Stationary Hospital at Bourg (Wisques) was
for a time being used for venereal patients, but this was stopped,
and the venereal patients were sent instead to No. 17 CCS. at
Arques. The 77th American Division had also at this time
come into the army area and its medical units were taking
over two field ambulances of the 39th Division for training.

During May the Second Army front was comparatively
quiet, although it was frequently bombarded by gas shells and
suffered from air raids which caused much damage in the
back areas, notably at St. Omer, where No. 10 Stationary
Hospital was bombed during the night of the 21st/22nd May,
tv/o officers and six other ranks R.A.M.C and four patients being
killed, and eight of the R.A.M.C. and ten patients wounded.
No. 10 Stationary Hospital was then closed and was transferred
to a safer situation at Clerques. Most of the enemy activity
against the front line was directed against the French divisions,

GERMAN OFFENSIVE ON THE LYS, 1918 267

as many as 228 of their officers and 7,156 other ranks having
been admitted to Second Army medical units between the
date of the arrival of the French divisions in the area and the
22nd May.

In June considerable changes took place in the situation of
the medical services of the Second Army. Arrangements
were made for the French divisions to be withdrawn towards
the end of the month ; the XlXth and Xth Corps joined the
Army in their place, and American divisions arrived in back
areas for training. Nos. 2 and 15 C.C.Ss. were transferred to
the First Army on the 27th June.

The general situation for the disposal of sick and wounded
of the Army was then as follows : —

Bergues . . Nos. 10 and 44 C.C.Ss. for wounded
of the Ilnd Corps.

Esquelbecq No. 3 (Australian) and No 2 (Canadian)
C.C.Ss. for wounded of the XlXth and
Xth Corps.

Blendecques Nos. 1 (Australian) and 2 (Australian)
C.C.Ss. for wounded of the XVth Corps.

The other units around St. Omer received the infectious,
N.Y.D.N., Chinese labour and venereal cases as before, but
gassed cases went to No. 64 CCS. at Watten. Nos. 36 and 63
were being moved.

Medical Services of Corps. — The corps of the Second Army
which were chiefly engaged during the fighting of April were
the IXth and XXIInd. The 25th, 19th, 21st and 9th Divisions
of the IXth Corps were on the Wytschaete-Messines front
on the 9th April ; but the corps was withdrawn, and the 9th
and 21st Divisions were thus transferred to the XXIInd Corps.
The remaining divisions then in the corps, 19th, 25th and 34th,
were handed over to the VHIth Corps in reserve on 24th April
and the IXth Corps then moved south to the Sixth French
Army at Fere-en-Tardenois. On the 16th April the French
divisions commenced to take over the area previously occupied
by the IXth Corps, between the XVth and XXIInd. Neither
the IXth nor the XXIInd Corps divisions were heavily engaged
on the 9th April, but subsequently the brunt of the fighting
fell on them, and especially on the 25th and 19th Divisions
of the IXth Corps on the 10th to 16th April, and on the 9th
Division of the XXIInd Corps on the 25th April. The
casualties admitted into field ambulances of the 25th Division

(10134) x

268

MEDICAL HISTORY OF THE WAR

during the 10th and 15th April were as follows for each
twenty-four hour period from 6 a.m. on 10th to 6 a.m. on the
15th :—

Date.

25th Division.

Other
Formations.

Total.

Offs.

O.R.

Offs.

O.R.

Offs.

O.R.

10th to 11th
11th to 12th
12th to 13th
13th to 14th
14th to 15th

31
13

5
3

992

320

115

366
112
753
259

46
18
46
20
6

1,358
432
868
320
130

The 25th Division was withdrawn from the line on the
15th April, but moved up to counter-attack at Kemmel on
the 26th April. The division joined the IXth Corps at
Fere-en-Tardenois on the 8th May.

The 19th Division was actively engaged on the Kemmel
front till the 18th April, when its front was taken over by the
•French 28th Division, but the field ambulances of the 19th
Division continued to work for the French until the 21st
April. The losses in the medical personnel of this division
during these operations were 1 officer and 23 other ranks
missing, 10 other ranks killed, and 27 other ranks wounded.
Four motor ambulance cars were totally destroyed by shell
fire. The other casualties in the division were 33 officers
and 872 other ranks admitted to its own field ambulances,
and 21 officers and 792 other ranks admitted to field ambu-
lances of other divisions. In addition, 60 officers and 1,952
other ranks from other formations passed through 19th
Division field ambulances.

Field ambulances of the divisions of the IXth and XXI Ind
Corps, as the British front was driven back, were gradually
concentrated at Remy Siding. Main dressing stations for
stretcher cases were opened there by several divisions.
Walking wounded were taken farther north to the casualty
clearing station site at Mendinghem. The wounded were
admitted into main dressing stations of divisions indiscri-
minately, and this accounted for the large numbers of wounded
of other formations who were received into the field ambulances
of the 25th and 19th Divisions.

The 34th Division, which was on the left of the XV th Corps
in front of Armentieres when the German offensive was

GERMAN OFFENSIVE ON THE LYS, 1918 269

launched, was heavily shelled with gas shells on the 8th ApriL
It was estimated that about 20,000 gas shells were thrown
into the town. The main dressing station of the division
fell back to No. 2 CCS. site at Oultersteene on the 10th ApriL
The wounded and gassed were evacuated through Nieppe.
On the night of the 12th/13th the 34th Division relieved the
25th Division and held the line north-east of Bailleul until
it in its turn was relieved by French divisions on the 21st April.
At Oultersteene a large amount of stores and equipment of
the casualty clearing stations had been left behind but much
of it was salved by the XVth Corps medical units.

Ambulance Transport during the Offensive.

There were few special incidents in connexion with the
work of the ambulance transport of divisions and convoys.
The First Army had Nos. 2, 8, 12, 13, and 25 M.A.Cs., and
the Second Army Nos. 4, 5, 6, 14 and 20 M.A.Cs. These
were distributed to corps or held as Army reserve, and as had
now become a recognized custom they were supplemented by
lorries for bringing walking wounded back. The light
ambulance wagons of the field ambulances were in some
cases able to go forward as far as the regimental aid post
positions, and much use was also made of the horsed ambulance
wagons for the sitting casualties. As in the retreat on the
Somme, the roads leading to the fighting line were much less
damaged than in those battles in which the British line advanced
instead of falling back. The usual complaints were made of
the difficulty in getting wounded away from advanced dressing
stations when the field ambulance transport was ordered —
as they were ordered in one corps — to take the wounded
back to casualty clearing station positions instead of to main
dressing stations. This procedure was noted in A.Ds.M.S.
diaries to interfere seriously with clearing the front areas
and was a repetition of what gave rise to similar complaints
by divisional A.Ds.M.S. in previous battles, as well as being
contrary to the principles laid down by the D.G.M.S. in his
memorandum of 2nd April. The depth of the German advance
at its farthest point was not more than ten or eleven miles,
as compared with forty to fifty in the offensive on the Somme,
and consequently the distance from the front line to the
casualty clearing stations in the back area became relatively
greater when the advance was checked.

270 MEDICAL HISTORY OF THE WAR

The Casualties.

The casualties admitted into the medical units of the First
and Second Armies from the 8th April onwards are shown
in the following table.

Casualties admitted to First and Second Army medical units
during the Lys Offensive in April.

Field

Casualty Clearing

Ambulances.

Stations.

Date.

First

Second

First

Second

Army.

1918.

8th April .

1,354

1,642

9th ,

3,426

3,797

636

10th ,

1,391

2,506

3,321

11th ,

2,271

1,296

2,271

4,198

12th ,

1,759

3,580

13th ,

862

2,840

14th ,

638

1,666

15th ,

710

1,444

16th ,

328

2,527

17th ,

2,362

400

2,987

18th ,

1,146

1,419

1,869

19th ,

516

483

748

20th ,

412

467

546

21st

523

530

458

593

22nd ,

635

368

720

553

23rd ,

566

456

599

673

24th ,

512

365

587

823

25th ,

496

720

520

4,064

26th ,

395

1,317

446

2,446

27th ,

845

199

1,755

28th ,

598

439

712

29th ,

319

1,640

378

2,000

30th ,

378

246

769

The large number of casualties in the First Army on the
8th April was mainly due to the gas attack on the 34th Division
on the Armentieres front. Afterwards, what had been the
normal line of evacuation of the 34th and 40th Divisions of the
XVth Corps, namely, to casualty clearing stations at Havers-
kerque, became a line running parallel to the line of the enemy's
advance, and consequently the wounded of the XVth Corps
divisions had then to be evacuated in the direction of Haze-
brouck, Godewaersvelde, or Remy Siding, the main dressing
stations retiring in the same direction, at first towards
Oultersteene. This fact accounts for the comparatively

GERMAN OFFENSIVE ON THE LYS, 1918 271

large number of wounded received into the Second Army
casualty clearing stations after the 9th April. Thus the
40th Division, which was in the XV th Corps until the 12th
April, and the Xlth Corps until the 14th, had collected some
1,596 wounded, who were evacuated to Hazebrouck or
northwards to Remy Siding between the 9th and 14th April.
On the Aire-La Bassee Canal front the direction of eva-
cuation was at first through main dressing stations in the
Seminaire St. Vaast at Bethune, until they were shelled out
on the 10th April, and afterwards through Chocques to the
casualty clearing stations at Lozinghem and Pernes. The
Xlth Corps front at the point of the salient was cleared through
main dressing stations at Busnes and Ham-en-Artois in the
direction of St. Omer and Pernes. The medical units of the
55th Division, which held its ground along the La Bassee
Canal, received most of the wounded from the southern area.
Between the 9th and 16th April its field ambulances admitted
a total of 119 wounded officers and 2,403 other ranks, of
whom 47 officers and 1,032 other ranks belonged to other
divisions.

Casualties amongst the Civil Population.

In reviewing the work of the medical services during the
Lys offensive certain features stand out in contrast with the
work of the medical services in the Somme offensive during
the previous month. The Fifth and Third Armies went
back under the enemy pressure in March over the de-
vastated area of the Somme battles of 1916 ; whereas the
area through which the enemy forced back the British,
Portuguese and French in the First and Second Army areas
in April had been more or less undamaged by battle since
the British occupied the line between Armentieres and the
Aire-La Bassee Canal in 1914. There were many towns and
villages in this area, and few of the civil inhabitants had
left their homes. Consequently Bethune, Estaires, Merville,
Armentieres and numerous villages were full of old men,
women and children when the German attack was launched.
It thus happened that when these places were shelled and
bombed, and more especially when enormous numbers of
gas shells were thrown into Armentieres and Bethune, the
casualties amongst the civil inhabitants were extremely
numerous and distressing. British medical units and ambu-
lance convoys at once came to their assistance, and were
actively engaged in bringing the sick, wounded and helpless

272 MEDICAL HISTORY OF THE WAR

civilians back to places of safety. For example, No. 1 M.A.G.
had been sent up to Bethune from G.H.Q. by the D.G.M.S.
and brought back a large number to the French hospitals at
Hesdin. Again, St. Venant Asylum, whose director, Dr. Cortyl,
had throughout the war been indefatigable in providing
accommodation for and assisting the Indian, British and
Portuguese casualty clearing stations which occupied in turn
a portion of the buildings, was full of insane women. It was
being heavily shelled and had become untenable, except by
an advanced dressing station. The 61st Division had opened
a main dressing station there on the 12th April, but had to
withdraw it on the following day. There were then 870
mental cases in the asylum together with the staff, and some 60
women and children in a neighbouring hospice. These were
all evacuated under the supervision of the D.D.M.S. of the
XI th Corps. They were taken from St. Venant in lorries
and entrained at Berguette between 1 a.m. and 9.30 a.m.
on the 15th April.

As an instance of how little did the inhabitants of the villages
in the area of the 55th Division anticipate the impending
disaster, the A.D.M.S. of the Division notes that he had to
clear bedridden civilians from cellars in the Chateau of La
Gorre on the canal in front of Bethune on the 11th April,
at a time when his regimental aid posts and advanced dressing
stations were strung out along the Canal between Bethune
and Givenchy.

CHAPTER XVI.

THE BRITISH MEDICAL SERVICES WITH THE FRENCH ON
THE AISNE AND THE MARNE, MAY TO AUGUST 1918.

WHILE the German offensives were being made on the
British line in front of Hazebrouck from April to June
1918, there was considerable activity farther south. Severe fight-
ing took place around Villers Bretonneux on the 24th and 25th
April, in which the elements of the 18th and 8th Divisions
of the Illrd Corps on the right and of the 3rd and 4th Austra-
lian Divisions of the Australian Corps in the centre and on the
left were engaged. The Fourth Army, in which these corps
were at the time, had its casualty clearing stations along the
Somme Valley between Amiens and Abbeville, chiefly at
Longpre, Picquigny, Pernois, Crouy and Vignacourt. The
number of wounded was comparatively small and the general
organization and scheme for their collection and evacuation
presented no difficulties.

The German Offensive on the Aisne.

A different situation, however, arose in connexion with the
British divisions of the IXth Corps which formed part of the
Sixth French Army on the Aisne front. These divisions had
passed through a period of severe fighting and had been trans-
ferred to a quiet area for rest and training in exchange for the
French divisions sent to support the right of the British line on
the Flanders front. Three of the divisions, the 21st, 8th and
50th, were put into the French front line, during the first
fortnight of May, on a front of about fifteen miles between
Bermicourt and Bouconville, north-west of Rheims. The
25th Division was in reserve. The French Sixth Army was
attacked by overwhelming numbers from Rheims to Soissons
at 1 a.m. of the 27th May. The whole of the IXth Corps
front was thus involved, as well as the French Corps holding
the Chemin des Dames on its left. The fighting continued
for several days, all the divisions of the IXth Corps being
engaged. The line was forced back to the Marne, the IXth
Corps being pressed back on the centre and left " to a position

274 MEDICAL HISTORY OF THE WAR

facing west and north-west between the Aisne and the Vesle."*
On the 28th May the corps retired across the Vesle and Ardres.
The 19th Division, which had been with the VHIth Corps in
reserve, was then brought up in buses to fill the gap between
the IXth Corps and French on its left. The British divisions
then came under the command of the French Fifth Army
and withdrew to the line Aubilly-Chambrecq-Boujacourt.

The Medical Services of the IXth Corps during the German
Offensive on the Aisne.

The medical services with the IXth Corps during these
operations were administered by Colonel R. J. Blackham,
who had succeeded Colonel J. B. Wilson as D.D.M.S. of
the Corps on the 17th May. He had with him two casualty
clearing stations, the 37th and the 48th, the former from Italy
under Lieut-Colonel Gray, and the latter, under Lieut. -Colonel
Henchley, from Ytres after it had been refitted at Boulogne.
The D.D.M.S. 's office was opened at Fere-en-Tardenois on the
27th April. No. 37 CCS. was placed in huts in a section of
a French Hopital d' Evacuation at Mont Notre Dame on the
following day, but infectious cases were sent to French medical
units at Jouaignes or Igny l'Abbaye, and continued to be
sent there. No. 48 CCS. left Boulogne on the 16th May
and arrived on the 19th at Montigny-sur-Vesle, where it also
took over a part of a French Hopital d'Evacuation. It
opened for admission of patients on the 23rd May.

In anticipation of the attack, Colonel Blackham had prepared
a well thought out scheme under the administrative control
of the D.M.S. of the French Sixth Army. He did not hear
of the impending attack, however, till 6 p.m. of the 26th May.
He then met the A.Ds.M.S. of divisions and the officers com-
manding the casualty clearing stations and other medical
units. A.Ds.M.S. were instructed to work their field ambu-
lances in echelon and be prepared to move back rapidly in
the case of a hostile advance. This echelon scheme was
designed to* bring the main dressing stations gradually back
to and behind the divisional rest stations. The main dressing
stations would thus be established in echelons, and as each
field ambulance retired it formed a new post to which wounded
were taken for evacuation farther back. An important
instruction was that the divisional motor ambulance cars
were not to proceed farther back than these main dressing
station positions.

* Sir Douglas Haig's despatches, p. 253.

French

SKETCH MAP OF MEDICAL SITUATION OF FRENCH SIXTH ARMY

ON THE A1SNE.

MAY 2QTH 1918 .

Showing the relative positions of BrTush and French formations.

'Boundary of zone of Army WWW//M Corps Boundary «•»««« Divisional Boundary

Posts for treatment of V.D.
Divisional Ambulances.
Corps D?

Army D?

Stationary Hospital.

m Casualty Clear inc/ Stat/

Hospital Centres on the L.of C.

BRITISH UNITS .
Main Dressing or Divsnl. Rest Station

Casualty Clear inc/ Station.

MaJby&Sons.bTJi

Medical Situation of the British IX Corps with the Sixth
French ArmyontheAisne, German offensive , May 27 t . h 1918.

+ Regmntl.A/d Post.

• R.A.M.C Bearer Post.

Car Loading Point.

Q Adv. Dressing Station.

JJ Main Dressing Station.

£ Dvsni. . Pest Sta t/on.

A Casualty Clearing Station.

Re&imental.Stretcher Bearers

— Hand Carriage, R.A.M.C. Bearers.
-m* Railway.

— Amovi-ance Cars.

— Oo . Da . f Might only).

15. 284-8 C.50GO/ I'M. ISOO.ll'Z'i.

H.M SO., Cr

MEDICAL SERVICES WITH THE FRENCH 275

The motor ambulance convoys at Colonel Blackham's
disposal for evacuating from the main dressing stations to
the casualty clearing stations were No. 31, which was with
him from the 4th May, and No. 42, which arrived from the
lines of communication on the 28th May in response to a
message sent on the night of the 26th May for an additional
motor ambulance convoy. A lorry convoy of thirty lorries
had also been organized and placed under an officer of the
R.A.M.C.

Arrangements had been made with the French for British
ambulance trains to run to the British casualty clearing
stations, but the arrangements had not come into effect when
the operations commenced. A telegram was sent to G.H.Q. at
8 p.m. on the 26th asking for two trains to be sent to the corps
area at once and for six others to be within reach. The Q.M.G.
at G.H.Q. had informed the IXth Corps Commander that
there should be no difficulty in getting eight ambulance trains
up every twenty-four hours, but asked that the details should
be arranged with the French Sixth Army.

The instructions to the casualty clearing stations were to
clear the walking wounded first, and to have their equipment
ready for transport back by train or lorry. The personnel
of the casualty clearing stations were given a rendezvous at
Fere-en-Tardenois in the event of their having to withdraw.
No. 17 Advanced Depot of Medical Stores, which had
arrived in the IXth Corps area on the 10th May and had
been established with No. 37 CCS. at Mont Notre Dame,
was given the same rendezvous in the event of a retirement
being necessary.

The other medical units with the corps were No. 16 (Bacterio-
logical) and No. 22 (Hygiene) Mobile Laboratories. The former
was with No. 37 CCS. and the latter with No. 48 CCS.
There were also an X-ray unit with No. 48 CCS. and a dental
unit with No. 37.

The IXth Corps medical units were thus either at Mont
Notre Dame behind the left, or at Monti gny-sur-Vesle behind
the right of the IXth Corps front, at a distance of some seven-
teen and seven miles respectively from the front line. The
divisional medical units and two sanitary sections, Nos. 45
and 119, were occupying various villages between them and
the front. It should be noted, however, that Mont Notre
Dame was outside the area assigned to the IXth Corps by
the staff of the French Sixth Army, who had fixed the localities
to which the casualty clearing stations should be sent.

276 MEDICAL HISTORY OF THE WAR

When the attack commenced steps were taken at once to
withdraw No. 48 C.C.S., as it was nearest the line, but only
two lorry loads were got away to Fere-en-Tardenois, about
thirty miles behind the line. Wounded poured into No. 48
CCS. during the day. Five hundred were evacuated by a
French ambulance train at 1 p.m. The train got away
just before the line was cut at Fismes. About 1,500 patients
were dealt with and cleared from this casualty clearing
station up to 6 a.m. on the 28th May. The unit was then
abandoned, the entire personnel and lorries escaping before the
position was captured. Forty severely wounded had to be
left behind.

The rapid advance of the enemy towards Mont Notre Dame
was unforeseen and came as a surprise. The railway line was
cut at 10 p.m. on the 27th May, so that evacuation by ambu-
lance train was impossible, but a French ambulance train
had already cleared 500 British wounded from No. 37 CCS.
The walking wounded were sent to Fere-en-Tardenois, and
arrangements were made to send off in cars and lorries whatever
material and personnel could be spared from the service of
the wounded. These arrangements, however, fell through,
as the Germans entered the hospital at 1.30 a.m. on the
28th May and all communications were broken. The whole
of the British and French casualty clearing stations and their
wounded were thus captured together with their personnel.
Four R.A.M.C officers, one dental surgeon, three chaplains
and six other ranks of No. 37 CCS., however, got away.
The Commanding Officer, Lieut-Colonel Gray, four other
R.A.M.C. officers, the Quartermaster and the rest of the unit
remained with the wounded. No. 17 Advanced Depot of
Medical Stores was also captured. The other units got away
to the rendezvous at Fere-en-Tardenois.

After these events and until the German advance was
checked, British wounded were received into French hospitals
during the different stages of the retreat, the personnel of
No. 37 and No. 48 C.C.Ss. or of a field ambulance being attached
for duty in them. The evacuation hospitals were thus
successively at Dormans on the 28th May, Chateau-Thierry,
Dormans and Epernay on the 29th, Dormans, Epernay and
Vertus on the 30th, Epernay and Vertus on the 1st and Vertus
on the 2nd June.

British ambulance trains were able to come up to clear
the British wounded from Dormans on the 29th May, but
throughout the operations many of the wounded were cleared

SKETCH MAP OF THE MEDICAL SITUATION OF THE BRITISH IX CORPS WITH
THE SIXTH FRENCH ARMY ON THE AISNE, DURING THE GERMAN OFFENSIVE, MAY-JUNE 1918.

Malby&Sons.Lith.

MEDICAL SERVICES WITH THE FRENCH 277

by the French in cars and ambulance trains in a southerly
direction to French hospitals, their destination being deter-
mined by the French authorities.

The Vlllth Corps was in reserve behind the IXth Corps
with headquarters at Chalons-sur-Marne during these opera-
tions. No. 62 CCS. was established with it at Bussy-
le-Chateau, and on the 9th June, No. 32 CCS. was sent up
and opened under the IXth Corps administration at Sezanne.
Wounded were taken to the former by motor transport from
Epernay on the 29th and 30th May, and to the latter both
by ambulance transport and ambulance trains at a later
date.

The situation and movements of the medical units and the
evacuation of sick and wounded from them may be followed
from the sketch maps.

The chief difficulties were the short notice of the attack,
lack of information during the battle, and the rapidity of the
enemy's movements. The D.D.M.S. of the IXth Corps
received information of the impending attack less than eight
hours before it took place. At that time the field ambulances
were in buildings or huts which had been taken over from
the French when the British divisions went into the line. The
accommodation in them was so good and ample that divisions
were inclined to retain in them as many cases of sickness as
possible in order to avoid wastage. The result of this was
that 1,023 sick were in the divisional areas when notice of
the attack was received. Many were at once returned to duty,
but the casualty clearing stations were immediately filled
with and hampered by the reception of some 400 or 500 of
these cases. Further, No. 37 CCS. was outside the corps
boundary, and the D.D.M.S. was not aware of its position
being threatened until 6 p.m. of the 27th May. Attempts
then to communicate with it failed owing to the enemy having
come between it and corps headquarters. The D.D.M.S., in
ignorance, therefore, of what was happening on the left flank,
concentrated his attention on clearing No. 48 CCS. which
was much nearer the front line. No. 37 CCS. was so far
back that it seemed inconceivable that its position would be
threatened during the first twenty-four hours. The advance
of the Germans of twenty-nine miles in one day was in fact
entirely outside the experience of the offensives against the
British fronts on the Somme and the Lys.

The number of wounded and sick received into the field
ambulances and casualty clearing stations of the IXth Corps

278

MEDICAL HISTORY OF THE WAR

from the 27th May to 19th June was as follows, exclusive of
those in No. 37 C.C.S. at the time of capture : —

Sick.

Wounded.

Ofifs.

O.R.

Offs.

O.R.

Field ambulances
Casualty clearing stations

116

2,122
1,947

170
170

4,457
4,292

The motor ambulance convoys cleared 8,102 and ambulance
trains 11,944; of whom 6,517 went to British hospitals at
Rouen and the others to French hospitals in various parts
of France. No. 31 M.A.C. had the greatest strain thrown on
it during the first two days, until it was relieved by No. 42
M.A.C. The numbers missing were reported to be 773 officers
and 11,147 other ranks, and the numbers killed, 98 officers
and 454 other ranks.

The losses in medical personnel were correspondingly great.
They were as follows : —

Killed.

Wounded.

Missing.

Officers
Other ranks

3
15

4
80

45
497

The missing included the A.D.M.S., Colonel Milne-Thompson,
of the 50th Division and his D.A.D.M.S.

The loss in British medical equipment and stores was not
so great, as much of the equipment used belonged to the
French medical units in the localities taken over by the
British. No. 25 Field Ambulance of the 8th Division, No. 37
C.C.S. and No. 17 Advanced Depot of Medical Stores were in
fact the only units which were captured intact. The losses
in ambulance transport between the 27th May and 2nd June
were, however, considerable. The 50th Division lost twelve
of its motor ambulance cars, the 8th Division eleven, and
the 21st and 25th Divisions one each. No. 31 M.A.C. lost
seven cars. Five horsed ambulance wagons were also lost,
three in the 8th Division and two in the 21st. There was
also a loss of twenty-five stretcher carriers in the divisions.

While the IXth Corps was thus engaged with the French
on the Aisne front, the VHIth Corps with the 19th Division
only had its headquarters at Chalons-sur-Marne, where its

MEDICAL SERVICES WITH THE FRENCH 279

D.D.M.S., Colonel Shanahan, was in close touch with the
administrative medical officers of the French Fourth Army.
The A.D.M.S. of the 19th Division had opened his office at
St. Germain la Ville. No. 62 C.C.S., which had been sent to
the French front with the VHIth Corps, after several sites
had been proposed was eventually placed in a French hospital
at Bussy-le-Chateau. No. 11 M.A.C., No. 19 Advanced
Depot of Medical Stores and No. 14 X-ray Unit were also
with the Vlllth Corps at this time. The 19th Division was
transferred to the IXth Corps on the 28th May, as noted
above. Many British wounded from the Aisne front were
then being received into French hospitals at Chalons, and
the D.D.M.S. of the Vlllth Corps had his time occupied in
arranging for their transfer to No. 62 CCS. This was carried
out by No. 11 M.A.C

On the 4th June No. 19 Advanced Depot of Medical Stores
was transferred from the Vlllth to the IXth Corps and placed
at Sezanne.

In order to co-ordinate the work of the British units in
the French areas a G.H.Q. (South) was now formed, and on
the 5th June Colonel Shanahan, the D.D.M.S. of .the Vlllth
Corps,* was appointed D.D.M.S. at this G.H.Q. for adminis-
tering the British medical services. His headquarters were
at La Ferte Gaucher.

The Medical Situation after the German Offensive.

The IXth Corps remained with the French on the Marne
front until the 5th July, when it was transferred to the Fourth
Army and occupied the area behind the junction of the French
and British on the Amiens front, replacing the XXIInd Corps,
which was then transferred to the area previously occupied
by the IXth Corps on the Marne. No. 32 CCS. had been
sent to the IXth Corps area, after having been refitted at
Etaples, on the 9th June, and was established at Sezanne,
with the personnel of No. 48 CCS. attached to it. On the
25th June, No. 48 CCS. was sent to Rouen to refit, and No. 32
CCS. was transferred to the reconstituted Fifth Army and
opened at Elnes near St. Omer. No. 62 CCS. was transferred
to the Second Army and went to Arneke. No. 31 M.A.C

* The Vlllth Corps left for Long, eight miles east of Abbeville, in the Fourth
Army back area, on the 15th June, where the 8th and 21st Divisions came
under its administration. No. 62 CCS. was, however, left with the IXth
Corps at Bussy-le-Chateau. On the 24th June the Vlllth Corps as a corps
was broken up and ceased to function.

280 MEDICAL HISTORY OF THE WAR

went to the First Army and No. 42 M.A.C. to G.H.Q. (Hesdin).
No British medical units were thus left with the French on the-
departure of the IXth Corps. Consequently, when the XXIInd
Corps arrived about fourteen days later it brought with it
fresh medical units. Its divisions were the 51st and 62nd.
No. 48 C.C.S., after being re-equipped at Rouen, joined it at
Vertus on the 21st July. No. 50, which had been refitting
at Etaples after the Somme offensive, was also sent to the
XXIInd Corps and opened at Sezanne on the 19th July. It
had with it No. 31 Advanced Depot of Medical Stores and
No. 13 Mobile X-ray Unit. Nos. 42 and 44 M.A.Cs. were
also attached to the XXIInd Corps in July, but the latter
was held in reserve by the D.D.M.S., G.H.Q. (South).

Two British divisions, the 15th and 34th, were attached
to the French Groupe d'Armees de Reserve (G.A.R.) formed
of the French Third and Tenth Armies. Both divisions
were placed with the Tenth Army, the 15th with the French
XXme Corps d'Armee, and the 34th with the XXXme Corps
d'Armee. Nos. 16 and 17 M.A.Cs.; No. 63 CCS. and No. 3
Advanced Depot of Medical Stores were sent to work with
them, the two latter units to Senlis. They were thus in the
area behind the Forests of Compiegne and Villers Cotterets.
The medical administration of the XXIInd Corps and the
British units with the G.A.R. was then co-ordinated by the
D.D.M.S., G.H.Q. (South), at La Ferte Gaucher. Colonel
C. E. Pollock had at that time replaced Colonel Shanahan,
but a D.D.M.S., Colonel T. P. Jones, was appointed specially
as D.D.M.S. of the British Forces with the French G.A.R.
owing to the distance between the XXIInd Corps units and
the 15th and 34th Divisions. His headquarters were at CreiL
For general administration he came under Colonel Pollock,
but he did not take up his appointment until the 25th July.
Up till then the arrangements for medical units behind the
15th and 34th Divisions were being made by Colonel S. Gallie,
from the L. of C, under Colonel Pollock's direction.

The French Offensive on the Marne.
After the close of the operations in which the IXth Corps
had been engaged, the allied counter-offensive, which marked
the commencement of the advance to victory, was launched
by the French Groupe d'Armees de Reserve " on the front
between Chateau Thierry and Soissons," supported " by
vigorous attacks on other parts of the German Salient."*

* Sir Douglas Haig's despatches, p. 255.

MEDICAL SERVICES WITH THE FRENCH 281

The 51st and 62nd Divisions of the XXI Ind Corps and the
15th and 34th Divisions with the French Tenth Army were
involved in these attacks on the right and left of the French
main attack. The XXIInd Corps had just arrived at Vertus
when the operations commenced. The 51st and 62nd Divisions
went into the line on the 19th July, and attacked at dawn
the following day. The fighting continued on this front till
the 28th July, and resulted in the recovery of the positions
from which the IXth Corps had withdrawn in the previous
fighting at the end of May and beginning of June. The
divisions were then relieved and entrained with the XXIInd
Corps for the British zone between the 2nd and 4th August.

The two British divisions, the 15th and 34th, with the
French Tenth Army went into the line on the night of the
22nd/23rd July, and attacked on the left flank of the salient
at Berzy-le-Sec and Parcy Tigny, south-west of Soissons.
They continued operations in that area. The fighting was
especially heavy on the morning of the 29th July at Buzancy,
when the 34th Division was moved southwards to a line facing
Oulchy-la-Ville, and the 15th Division to a line in front of
Villemontoire. The attack was continued in that area on the
morning of the 1st August. The divisions were relieved on
the night of the 3rd/4th August and entrained for the British
zone on the 5th August.

The Medical Services with the XXIInd Corps during the
French Offensive.

The medical arrangements of the XXIInd Corps during these
operations are indicated in the sketch map on the next page.

No. 50 CCS. arrived at Sezanne with mobilization equip-
ment only, that is, for 200 beds, but this was supplemented
by the French. No. 48 CCS. at first went to Vertus, but on
the 24th July a detachment was sent to the Hopital Auban
Moet, Epernay, to form an advanced operating centre, in
conjunction with a field ambulance already there. The
remainder of No. 48 then took over a hospital at Chaltrait-au-
Bois of 300 beds from the Italians, who with American
troops were also with the French armies in Champagne. This
hospital was between Vertus and Montmort, nine miles south
of Epernay, and was used for walking wounded, gassed cases
and sick. Sezanne was still farther south, about fifteen miles
from Epernay.

282

MEDICAL HISTORY OF THE WAR

Sketch map showing posit ions of medical, posts of
the 5l^ T &62 N PDvsws.(§[iJ Corps) with the Sixth
French Army, during operations of July 1918, on
the Eastern flank of the Marne salient.

■■-¥ 4^%*^£

Sc*i/& o? /T>//<& S

Vertus.

MEDICAL SERVICES WITH THE FRENCH 283

The Casualties.— The number of wounded collected by the
divisions of the XXIInd Corps between the 20th and 29th
July is not very clearly recorded, but the D.D.M.S. of the
corps notes the following as having been evacuated from the
field ambulances to casualty clearing stations from the 21st
July onwards : — ■

21st July 1,312

22nd
23rd
24th
25th
26th
27th
28th
29th
30th
31st

819
415
953
180
72
102
387
367
148
157

The main dressing station of the 51st Division records the
admissions of 101 officers and 1,466 other ranks between
the 20th and 31st July, and the main dressing station of the
62nd Division 2,077.

The two motor ambulance convoys, Nos. 42 and 44, were
working from Epernay and Vertus in evacuating wounded
from the main dressing stations to Nos. 48 and 50 C.C.Ss.
The French also provided a number of lorries for the evacua-
tion of walking wounded.

Some of the British casualties were also taken by an Ameri-
can ambulance train to an American hospital in Paris on the
23rd July.

The whole of the arrangements for clearing the casualty
clearing stations was controlled by the French authorities.
Both British and French ambulance trains were employed.
While the British trains ran from the front to Rouen,
the French trains took the wounded to various French
hospitals at Chalons, Bar-le-duc and elsewhere, but chiefly
to Troyes, which was only some thirty miles south of Sezanne.
The A.D.M.S., Colonel Statham, of the British Paris adminis-
trative area, was in close liaison with Colonel Pollock, the
D.D.M.S., G.H.Q. (South), and the movements of the British
sick and wounded to Troyes and elsewhere were regulated
in such a manner that transfer from the French hospitals
to Rouen was being continuously effected.

(10134) X

284 MEDICAL HISTORY OF THE WAR

Colonel Owen Richards was attached to G.H.Q (South) as
consulting surgeon during the operations. Surgical teams
and nursing sisters were brought up to No. 48 CCS. advanced
operating centre at Epernay, the latter on the 29th July.
At No. 50 CCS. much assistance was given by the French
operating surgeons, and also by women drivers of a convoy
of the First Aid Nursing Yeomanry working with the French,
who took on duties of nursing at the casualty clearing station.

The Work of the Field Ambulances. — The two casualty
clearing stations and the motor ambulance convoys were not
ready for work on the night of the 19th/20th July. Conse-
quently the tent division of a field ambulance of the 62nd
Division acted as a casualty clearing station at Sezanne and
the tent division of a field ambulance of the 51st Division at
Auban Moet, Epernay, during the 20th July. The main dressing
stations of the 62nd Division were at St. Imoges, with a walking
wounded dressing station at Champillon. The motor ambu-
lance convoy cars began to work during the afternoon of the
20th, but were not in full working order till the 22nd. Con-
sequently considerable numbers of the lying down wounded
were held up at St. Imoges till then.

In the absence of an advanced depot of medical stores
at the commencement of the operations, there was difficulty
in maintaining an adequate supply of ' dressings, splints and
anti-tetanic serum at the main dressing stations, but much
assistance was obtained from the French.

The country was thickly wooded, and while this allowed
ambulance cars to come up, free from enemy observation,
much farther forward than on previous occasions, the bearers
found it specially difficult to find their way in the forest country.
Bandages were tied round the trees to mark the routes for
the stretcher bearers and walking wounded and this proved a
very effective and valuable method in wood fighting.

The regimental aid posts of the 51st Division were in the
Bois de Courton on the 20th July, with collecting posts to
which the cars could come up at Courton Ruine on the left
and at a hill outside Nanteuil on the right. The advanced
dressing station was at St. Imoges, and the main dressing
station at Champillon. During the fighting the collecting
posts to which cars could run advanced to St. Denis, then
to Marfaux, and finally to Chaumuzy. Two or more relays
of bearers worked through the wood to these car posts. The
main dressing station advanced to St. Imoges and the advanced
dressing station to Nanteuil.

MEDICAL SERVICES WITH THE FRENCH 285

The British Medical Services with the French Tenth Army
during the Offensive.

When the 15th and 34th Divisions with the French Tenth
Army attacked on the morning of the 23rd July they were
separated from one another by two French divisions, so that
it was difficult to co-ordinate the arrangements for the eva-
cuation of their wounded.

At No. 63 Casualty Clearing Station, Senlis, 1918.

No. 63 CCS. detrained at Senlis on the night of the 22nd/23rd
July. It opened in the College St. Vincent, Senlis, and was
ready to receive the first convoy of wounded which arrived
at 6 a.m. on the 23rd. It had been fully equipped by the
French, had accommodation for over 1,000 patients, and was
also conveniently near the railway station from which ambu-
lance trains ran direct to Rouen. Twelve French voluntary
aid nurses continued to serve in it, and were of great assistance
to the British nursing sisters of the unit. As this was the only
casualty clearing station serving the two divisions the work

(10134)

286

MEDICAL HISTORY OF THE WAR

was very heavy, especially in connexion with the unloading
of cars and entraining wounded. Consequently, fifty men of

"Gas" ward in No. 63 Casualty Clearing Station,
Senlis, July 1918.

the R.A.M.C. from field ambulances, fifty V.D. convalescents,
and forty-two other convalescents were attached to the unit
to assist in this work on the 26th and 28th July.

MEDICAL SERVICES WITH THE FRENCH

287

A walking wounded post for both divisions was established
at Halte St. Remy, three-quarters of a mile from Villers
Cotterets on the road to Puiseux. A tent sub-division from
each of the two divisions was stationed there with twenty
marquees from No. 63 CCS.

Corridor at College St. Vincent, Senlis,
No. 63 Casualty Clearing Station, July 1918.

The main dressing station of the 34th Division was at Largny,
twenty-three miles from Senlis, with an advanced dressing
station at Montremboeuf Farm, near Villers Helon. When
the division moved to Oulchy-la-Ville area, the main dressing
station was established at Chouy with an advanced dressing

288

MEDICAL HISTORY OF THE WAR

station at Billy-sur-Ourcq, and afterwards at Oulchy-la-Ville.
The Largny main dressing station was thirteen miles from the
front line, and the Chouy main dressing station five and a
half miles.

The 15th Division had its first main dressing station at
Coeuvres-et-Valsury, but did not then form an advanced
dressing station, the wounded being evacuated to the main
dressing station direct through loading posts in the Chazelle-
Chaudun Valley and at Chaudun. When the division moved to
Villemontoire area an advanced dressing station was formed

Sketch map showing positions of medical posts or the I5 t . h &54 t " British
Divisions with the Foench Groupe d'Armees de Reserve on the Western

FLANK OF THE MaRNE SALIENT DURING OPERATIONS OF JULY 1918-

at Lechelle. The distance of the main dressing station of the
15th Division from the casualty clearing station was thirty-one
miles and from the front line about seven miles.

The position of No. 63 CCS. at Senlis was undoubtedly
much too far back, but as the building was ready and the
casualty clearing station was required to take in wounded
within six hours of its arrival, no alternative site was
feasible at the time.

Permission was obtained from the French authorities to
pitch tents and bring up ambulance trains to Villers Cotterets,
and an application was made by wire on 29th July for a second
casualty clearing station to be pitched under canvas at Halte
St. Remy on the site of the existing walking wounded post.

MEDICAL SERVICES WITH THE FRENCH 289

Sick and Wounded admitted to C.C.S., Evacuated to Base, or
Died during the Operations of the 15th and 34th Divisions
on the Marne, from 6 a.m. 23rd July to 6 a.m. 5th August
1918.

Admitted.

Evacuated.

Died
of

For twenty-four

hours ending

Sick.

Wounded.

Sick.

Woi

nded.

6 a.m.

Off.

O.R.

Off.

O.R.

Off.

O.R.

Off.

O.R.

Off.

O.R.

July 24th . .

573

„ 25th.

650

855

„ 26th.

—

213

333

„ 27th.

427

467

„ 28th.

176

. —

—

„ 29th.

—

282

104

309

„ 30th.

624

749

„ 31st .

110

1,017

—

853

Aug. 1st .

220

350

„ 2nd .

—

405

317

, 3rd .

778

852

,, 4th .

208

—

„ 5th .

—

331

Totals

599

202

5,585

572

187

5,416

Total, 15th Div. ..

316

115

2,457

298

J03

2,364

Total, 34th Div. ..

283

3,061

274

2,985

Americans

—

Germans

—

Number and Disposal of British Sick and Wounded of 15th and
34th Divisions admitted to Allied Medical Units.

Units.

Total
Number.

To
CCS.

To
Interior.

Returned
to Duty.

Died.

Remaining
in Army
Area unfit
for Evacua-
tion.

American . .
French

133
170

125

Totals . . | 303

218

290 MEDICAL HISTORY OF THE WAR

In view, however, of the early withdrawal of the British
divisions this casualty clearing station was withheld. The
alternative of sending part of No. 63 CCS. to Halte St. Remy
as an advanced operating centre was considered, but it was
not thought practical owing to the high pressure at which
it was working. Several cases of severety wounded men
were taken instead to the French operating centre near Villers
Cotterets.

The relief of congestion at the casualty clearing station and
at the main dressing stations was the main consideration.
Consequently on three occasions, namely, July 29th, 30th and
August 2nd, when large numbers had to be dealt with, the
lightly wounded were sent down by ambulance train from the
walking wounded post at Halte St. Remy. The trains halted
at Senlis, and any patients who required immediate operation
were removed to the casualty clearing station and the train
loads adjusted. In this way 1,443 wounded were sent down
from Halte St. Remy by ambulance train, and 1,240 of them
went on to the base, without entering the casualty clearing
station. Owing to this expedient there was never at any
time congestion at the main dressing stations or at the casualty
clearing station.

The numbers of sick and wounded admitted and transferred
to the base during the period are shown in the table on the
preceding page. Most of those admitted to French or American
medical units were transferred to No. 63 CCS.

With the close of these operations the medical units were
distributed to the armies on the British front. G.H.Q. (South)
was closed on the 19th August, the last of the medical units,
No. 63 C C.S., having left on the 14th of the month.

CHAPTER XVII.

THE MEDICAL SERVICES DURING THE ADVANCE TO VICTORY.

THE period of offensive action by the British Armies, which
led to final victory and the Armistice on the 1 1th November
1918, has been divided into two phases ; the first a phase of
fighting in entrenched positions, and the second a phase of
fighting in open country.* The first phase was one in which
the enemy was driven out of one position after another to the
Hindenburg line between St. Quentin and the Scarpe, and
culminated in the British forces breaking through the Hinden-
burg line at the end of September and beginning of October
1918. Consequently the operations of this phase took place
in the devastated area over which the Battles of the Somme
in 1916, of Arras in 1917 and of the German offensive in 1918
had been fought. During the second phase the enemy was
driven back fighting rearguard actions over open country
until the British entered Maubeuge on the 9th and Mons on the
11th November, when hostilities ceased.

Outline of the Operations.
The British offensive was commenced by the Fourth Army
in front of Amiens, in combination with the French First
Army. The Canadian Corps was on the right, the Australian
Corps between it and the Somme, and the Illrd Corps on
the left, north of the Somme, the Fourth Army front extending
for some eleven miles from the Amiens-Rove road to Morlan-
court. The French First Army was placed under Sir D. Haig's
orders for the operations and was on the right of the Canadian
Corps. The Cavalry Corps was behind the Fourth Army
front east of Amiens. The attack, which was commenced
on the 8th August with massed artillery fire, was completely
successful, an advance of six or seven miles being made by
nightfall. It was continued on the 9th August and following
days, and was finally broken off on the 13th August after the
front had been advanced to a line from Dernancourt through
Bray and Proyart to the west of Chaulnes and Roye. The
three cavalry divisions, fourteen infantry divisions, including
the 33rd American Division, and 400 tanks took part in these
operations.

* Sir Douglas Haig's despatches, p. 257.
10134 Z

292 MEDICAL HISTORY OF THE WAR

This opening battle was followed by minor operations in
Flanders, including the capture of Oultersteene by the 31st,
29th and 9th Divisions of the Second Army on the 18th and
19th August.

The next great attack was opened by the IVth and Vlth
Corps of the Third Army on the 21st August. They attacked
on a nine-mile front north of the Ancre from Hamel to
Moyenneville, and advanced to the Albert-Arras railway
before night. The following day the Illrd Corps attacked
south of Albert and recaptured the town ; and then on the
23rd August the main attack on the enemy's entrenched
positions was launched along the whole front of some thirty-
three miles from the junction ot the British with the French
at Lihons, north-west of Chaulnes, to Mercatel, south of Arras.
The Australian and Illrd Corps of the Fourth Army south
and north of the Somme, and the IVth, Vth and Vlth Corps
of the Third Army were engaged. The fighting was continued
until the 1st September over the old battle ground of the Somme
in 1916. The British line at the close of the operations had
then been advanced to the Somme, south of Peronne, and
northwards through Peronne and Bapaume to the Scarpe, east
of Roeux. Twenty-three divisions had taken part in the
battle and had captured over 34,000 prisoners and 270 guns.
The enemy as a result of these operations had commenced to
shorten his line on the Lys salient, with the result that by the
2nd September the British front was advanced from Festubert
to Estaires and northward to Steenwerck and Kemmel ; Merville
and Bailleul were thus reoccupied although now reduced to ruins.

In the meantime the Canadian Corps, which had handed
over its area on the right of the Fourth Army to French troops
and had moved up to the right of the First Army, attacked
the German positions astride the Scarpe east of Arras on the
26th August on a front of five and a half miles and captured
Monchy-le-Preux. The First Army then continued to carry
the German positions and by the end of the month had come
within assaulting distance of the Hindenburg line from
Quean t to Drocourt south-west of Lens. On the 2nd Sep-
tember this line was attacked and broken by the XVIIth
Corps of the Third Army and the Canadian Corps of the First
Army, 8,000 prisoners being taken. In all 16,000 prisoners
had been captured during the battle of the Scarpe. Ten
divisions were engaged in the battle.

The next stage in the advance consisted of operations
against Havrincourt and Epehy between the 12th and 18th

THE ADVANCE TO VICTORY 293

September by corps of the Fourth and Third Armies. Both
these positions, it will be remembered, were positions around
which battles were fought in November and December 1917
by the Third Army. The vicinity of these villages was held
in strength covering the Hindenburg line. The Canal du
Nord, north of Havrincourt, was also strongly held by the
enemy. The positions in the Havrincourt sector were attacked
on a front of about five miles by the IVth and Vlth Corps of
the Third Army on the 12th September, and the villages of
Trescault and Havrincourt occupied. Further south the
IXth and Australian Corps pushed forward and captured
Holnon village, at the junction of the British with the French
line, by the 17th September. On the following day an attack
was then made by the Fourth and 1 hird Armies on a seventeen-
mile front between Holnon and Gouzeaucourt, in co-operation
with the French south of Holnon. The fighting was very
severe and took place in heavy rain. All the enemy's positions
and nearly 12,000 prisoners were captured by nightfall.
Fifteen divisions took part in these operations.

The final and decisive operations against the German
entrenched positions commenced on the 27th September and
ended on the 5th October. On the first day the IVth and
Vlth Corps of the Third Army and the XVI Ith and Canadian
Corps of the First Army attacked on a front of some thirteen
miles from Gouzeaucourt along the Canal du Nord to opposite
Sauchy-Lestree. The main feature of the operation was the
crossing of the canal in the neighbourhood of Moeuvres in
the centre of the attack, when the troops debouched fan-
wise north-west towards the Sensee Canal and southwards
towards the St. Quentin Canal at Marcoing, while the centre
pushed forward through Bourlon Wood in the direction of
Cambrai. Fourteen divisions took part. The operations were
completely successful, 10,000 prisoners were captured, and a
line secured from Beaucamp, north of Gouzeaucourt, through
Ribecourt, Fontaine-Notre-Dame to Epinoy and Oisy le
Verger, south of the Sensee Canal, the depth of the advance
at its centre being about four miles.

This attack was followed on the 29th September by art
attack delivered by the Fourth Army with the IXth, Ilnd
American Corps, and Illrd Corps ; by the French First Army
on its right, and by the Vth and IVth Corps of the Third
Army between Vendhuille and Marcoing on its left. The
attack was against the Hindenburg line and strongly defended
positions east and west of the Scheldt Canal, between Holnon

294 MEDICAL HISTORY OF THE WAR

and Vendhuille. In one section, between Bellicourt and
Vendhuille, the canal ran through a tunnel for some 6,000
yards. The righting was general all along the line and in
places against determined resistance ; but the Hindenburg
line was broken through in several places and the enemy's
rear defences taken, an advance being made to a depth of
some three miles to beyond Magny-la-Fosse in the centre of
the attack by the 46th Division, the troops of which had
swum or waded across the canal north of Bellenglise. The
two American divisions, the 30th and 27th, were heavily
engaged between Bellicourt and Bony near the canal tunnel,
with the 5th and 3rd Australian Divisions in support.

The Third Army had in the meantime crossed the Scheldt
Canal between Masnieres and the outskirts of Cambrai, and
the line had been advanced still further by the Canadian
Corps to the north-west of Cambrai. The fighting con-
tinued during the following days until the whole of the
Hindenburg line of defences had been broken through. St.
Quentin was occupied by the French on the 1st October, and
by the evening of the 7th October the British line ran due
north from St. Quentin to Cambrai and thence westwards along
the Sensee Canal to the old line north of Sauchy-Lestree. The
thirty British and two American divisions engaged in these
operations captured 36,000 prisoners and 360 guns

While these battles were being fought in the south of the
British front, a great advance was made in Flanders on the
Ypres front by the Belgian Army, some French divisions,
and the XlXth and Ilnd Corps of the Second Army, which
had been placed under the command of the King of the
Belgians for the operations. The XlXth and Ilnd Corps
attacked on the 28th September on a four and a half mile front
south of the Ypres-Zonnebeke road, the Belgians on their left
carrying on the front as far as Dixmude. The enemy's
resistance was slight, and the line by the evening of the 1st
October had reached the Lys from Armentieres to Comines,
and north of that town to a position west of Menin and east of
Moorslede ; a depth of some eight or nine miles from the
original position in front of Ypres.

The British front from Lens to Armentieres was also
advanced during this period to beyond Lens, La Bassee and
Armentieres by the withdrawal of the enemy from his positions
astride the La Bassee Canal. This front had been taken
over by the reconstructed Fifth Army under General Sir W,
Birdwood, the depth of the advance from the line held west

THE ADVANCE TO VICTORY 295

of Merville on 8th August being some twelve or thirteen miles
to Erquinghem within five miles of Lille.

The second phase of the advance to victory commenced
on the 8th October with an advance in open country to
Maubeuge and Mons by the Fourth and Third Armies and
the right of the First Army.

The first stage of this advance was against Le Cateau.
The operations were opened on the morning of the 8th October
by the Fourth and Third Armies on a front of over seventeen
miles from Sequehart, at the junction of the British right
with the French First Army, to south of Cambrai. On the
first day the line was advanced to near Cambrai. On the
following night Cambrai was entered and by the night of the
9th October the advance had reached to within two miles of
Le Cateau, where it was held up on the 10th October along
the west bank of the river Selle. Twenty British divisions,
two British cavalry divisions and one American division
took part in this advance, capturing 12,000 prisoners. The
depth of the advance was some thirteen miles. While these
operations were going on, the enemy, fighting rearguard actions,
withdrew from the area between the Scarpe, Douai and Lens,
and the 8th Division reached the outskirts of Douai on the
13th October. A similar retreat was effected in front of the
French, who occupied Laon on the 13th October.

On the north the force under the King of the Belgians
attacked along the whole front from the Lys at Comines
to Dixmude. The British sector of the force extended from
Comines to St. Pieter, half way between Menin and Roulers.
The Xth, XlXth and Ilnd Corps were engaged, with the
30th and 34th, 41st and 35th, and the 36th, 29th and 9th
Divisions respectively. There was considerable opposition,
but by the 16th October the British line was advanced to
beyond Menin as far as Courtrai, while the French and Belgian
troops further north had occupied Roulers and Thourout.
" Ostend fell on the 17th October and three days later the
northern flank of the Allied line rested on the Dutch frontier."*
Further south a movement towards Lille was commenced
by the VHIth Corps of the First Army, the Xlth Corps of the
Fifth Army, and XVth Corps of the Second Army. By the
evening of the 17th October Lille was entered, and the advance
was carried steadily eastwards until, on the evening of the 22nd
October, the general line of the Scheldt was reached from the

* Sir Douglas Haig's despatches, p. 290.

296 MEDICAL HISTORY OF THE WAR

western outskirts of Valenciennes and Tournai to some seven
miles east of Courtrai. This advance was a specially rapid
one extending as it did to a depth of some twenty miles between
the 17th and 22nd October.

While this advance was being made on the north, much severe
fighting was taking place on the Fourth Army front for about
ten miles from Le Cateau southwards. The IXth, Ilnd
American and Xlllth Corps attacked the enemy in that
sector on the 17th October in conjunction with the French
First Army west of the Sambre and Oise Canal opposite Guise.
The enemy offered a strong resistance, but by the 19th October
he was driven across the Sambre and Oise Canal. This was
followed by an attack on the line of the Selle, north of Le Cateau,
on the 20th October by seven divisions of the Third Army
and one of the First Army. Again there was determined
resistance with frequent counter-attacks. On the 23rd October
a fresh attack was made, at first by the IXth and Xlllth Corps
of the Fourth Army, followed by the Vth, IVth, Vlth and
XVIIth Corps of the Third Army along a fifteen-mile front
from the junction with the French, facing the Sambre, to the
north-east of Haussy. The next day the attack was extended
five miles northwards by the left of the XVIIth Corps and
XXIInd Corps of the First Army to the Scheldt, south-west
of Valenciennes. In spite of unfavourable weather, difficult
country and determined opposition, the British line was
advanced to a depth of six miles and ran along the Sambre
and the western outskirts of the Forest of Mormal to the
vicinity of Le Quesnoy. Twenty-four British and two
American divisions took part in this battle and captured
20,000 prisoners and 475 guns.

The final battle of the war on the Western Front was now
opened with the capture of Valenciennes after two days' fighting
on the 1st and 2nd November by the XVIIth Corps of the
Third Army and the XXIInd and Canadian Corps of the
First Army on a front of some six miles south of the town.
Following on this the main and decisive attack was made on
the 4th November by the Fourth, Third and First Armies on
a front of some thirty miles from the Sambre, north of Oisy to
Valenciennes. The attack was carried forward across the
river and through the Mormal Forest by twenty-six divisions
of the IXth, Xlllth, Vth, IVth, Vlth, XVIIth, XXIInd, and
the Canadian Corps. 19,000 prisoners were captured. On the
night of the 4th/5th November the enemy began to fall back
on his whole front. After that time the resistance was weak.

SKETCH MAP SHOWING THE MOVEMENTS OF CASUALTY CLEARING STATIONS DURING THE ADVANCE TO VICTORY.

Watte* ro1°" S

^% I
Esouelbccg. £% B ^jg „

c^Mxtt^-s^ ",^_

a n

&*+ f p a n c o - Bel n ;

landagham-'",, '

.&S'Hallu

/ Ate,/,?., .J*"*. .,\ "% a«So — f-^^Kmmel.

^Doulleos.

- ; ? s J xfesCorps- VeoquemonC "^Si.

.-/V G 7/ / / . ■■-.- \Vf A <^ \ / ^^T* To art/7 \ //(

|.>' , &'. ^~~»<3V-&Jo/M».«f 3 fl,„.---* few,','*,

■^^^ni^pT&SfijSfea^

H"t8CCSfro„Lj>r~C.t.

,„„,,»"'""""

i\ /

■ w

A CCS. Positions on November II 01 1918.

w C.CS's. brought up from L.ofC.
^n Stationary Hospitals at commencement of attack.

A Final position of Stationery Hospitals which mo</ed

<$ prior to November ll<* 1918.
.-- British Front Line et the beginning of the Advance.
«■■ ...Do. 0o.--.0o. at the time of the Armistice.

Intermediate positions of the British Line during the Advance.

|j5 ap Miles.

THE ADVANCE TO VICTORY 297

The advance was then rapid. Maubeuge was entered on the
9th November by the Guards and the 62nd Division, and Mons
on the 11th November by the 3rd Canadian Division after
considerable opposition.

At 11 a.m. on that day hostilities ceased.

The Medical Services with the Fourth Army.
The Battle of Amiens. — The preparations for the opening battle
on the 8th August by the Fourth Army were kept very secret.
In order to divert attention from the direction of the attack
some Canadian units and No. 1 and No. 4 Canadian C.C.Ss.
were transferred to Arneke in the Second Army area from
Pernes during the previous week, and no medical units were
permitted to be moved into the Fourth Army area before the
commencement of the attack. The Canadian Corps was then
being transferred to the Fourth Army from the First Army.
The D.M.S. of the Fourth Army, Maj. -General M. O'Keeffe,
was informed of the impending operations on the 6th August,
and at once applied to the D.G.M.S. for two more casualty
clearing stations, three motor ambulance convoys, fourteen
surgical teams and forty-eight extra nursing sisters. He
cleared all sick from casualty clearing stations to the base on
the 7th August, and ordered Nos. 53, 55 and 49 C.C.Ss. to
close' down and be ready to move suddenly with twelve lorry
loads of stores each. Over 4,000 sick were thus unloaded on
to base hospitals on the 6th and 7th August, a proceeding
which in itself was apt to indicate where the attack was likely
to take place, but too late for the enemy to take advantage
of any information so obtained, The Asylum just south of
Amiens on the Amiens-Dury road was marked down as a
suitable position to which the casualty clearing stations could
be brought forward. No. 48 CCS. was then on its way from
the French zone and was diverted to that locality.

The Fourth Army had twelve casualty clearing stations on
the 6th August placed as follows : —

Crouy . . . . Nos. 5 and 47.

Longpre . . Nos. 12, 53 and 55.

Pernois . . Nos. 4 and 41.

St. Riquier . . No. 49 and Lucknow.

Vignacourt . . Nos. 20, 61 and 37.
No. 41 Stationary Hospital was at Pont Remy.
The sketch map shows these positions. They were all
further back than had been usual in consequence of the ex-
periences during the German offensive earlier in the year.

298 MEDICAL HISTORY OF THE WAR

Consequently, only those at Pernois, Vignacourt and Crouy
were allotted for receiving wounded from the front line, those
at Pernois for the Ilnd Corps, those at Vignacourt for the
Australian Corps, and those at Crouy for the Canadian and
Cavalry Corps. The others were for the sick of back areas
and special cases.

Advanced depots of medical stores were at Vignacourt
(No. 13), Crouy (No. 14) and Longpre (No. 18). The motor
ambulance convoys with the Army were Nos. 3 and 11 allotted
to the Australian Corps, No. 10 to the Illrd Corps, Nos. 37
and 44 to the Canadian Corps, Nos. 24 and 42 as Army
Reserve. Some of the cars, however, of convoys No. 37 and
No. 44, which had arrived just before the battle com-
menced, had difficulty in getting up to the Canadian Corps
to which they were allotted owing to congestion of traffic
on the roads.

No. 48 CCS. on its way from the French zone arrived at
the asylum during the afternoon of the 8th August. The
asylum was the main dressing station of the Canadian Corps
at the time, and when the main dressing station was moved
forward, the wounded, some 500, left there were taken over
by No. 48 CCS.

There was some difficulty with regard to the supply of
surgical material to units of the Canadian Corps. They had
arrived without any surgical dressings and had to be hurriedly
supplied from the advanced depots. Lorries were sent to
Abbeville to replenish the depleted advanced depots, as
stores already requisitioned were being held up by congestion
of traffic on the railway.

Most of the surgical work during the 8th August fell on the
casualty clearing stations at Crouy, but at dawn next day
Nos. 55 and 53 were sent forward to Vecquemont and No. 49
to Boves, both positions being in advance of Amiens and
north and south respectively of the Somme. On the 10th
August No. 47 CCS. was closed and moved to the asylum,
and on the following day No. 61 CCS. was sent to Vecquemont.
No. 1 and No. 4 Canadian C.C.Ss. were now coming down
from the Second Army and were being placed at Boves. On
the 13th August No. 37 CCS., which had been refitted on a
mobilization scale after capture on the Aisne, was sent up to
the Fourth Army and detrained at Vecquemont. On the 14th
August No. 5 was closed at Crouy preparatory to going to
Vecquemont on the 21st August, and on the 17th August
No. 41 was also closed and sent to Vecquemont.

THE ADVANCE TO VICTORY

299

Between 6 a.m. on the 8th August and 6 a.m. on the 11th
August, the number of wounded received into the casualty
clearing stations of the Fourth Army was as follows : —

Offs.

O.R.

Germans.

Offs.

O.R.

8th-9th August 19 18..
9th-10th
lOth-llth „

353
245
183

6,597
3,974
4,236

676
814
342

Totals

781

14,807

1,832

The numbers consequently were considerably less than in
the first days of the great battles of 1915, 1916 and 1917,
but the difficulty of handling them was probably greater, as
the advance into the enemy's lines was to a depth of some
nine or ten miles and casualty clearing stations had not yet
been fully opened in the more forward areas. The situation
was met by the number of convoys in the Fourth Army having
been increased to admit of two being held in Army reserve,
and of two being allotted to the Canadian and Australian
Corps in place of the usual one.

The casualties amongst medical personnel during these
three days were four R.A.M.C., two C.A.M.C, one A.A.M.C.
and four U.S.A. medical officers killed and six wounded,
seventeen other ranks killed and sixty wounded.

As many as forty-eight surgical teams from the lines of
communication and other armies and sixty-four additional
nursing sisters were sent to the casualty clearing stations of
the Fourth Army between the 7th and 10th August. Until
the casualty clearing stations that were being moved forward
to the asylum, Boves and Vecquemont were ready, the
six casualty clearing stations at Pernois, Crouy and Vignacourt
had most of the work thrown on them.

As this was the first experience during the war of an advance
to a great depth necessitating a corresponding advance of the
unwieldy casualty clearing stations, the following note of the
20th August by the D.M.S. of the Army is of importance :

" Most of the casualty clearing stations which have moved up to date
have moved rapidly and at short notice. At first an attempt was made to
move casualty clearing stations with twelve lorry loads. The amount of
materials, etc., which they could carry on these loads was very limited and
quite insufficient to deal with casualties coming in from a big battle. This
was stopped and forty lorry loads were allowed. Frequently twenty lorries

300 MEDICAL HISTORY OF THE WAR

only were available, and they had to make two journeys in one day ; this
is quite satisfactory provided the distance moved forward is not too great

It is possible for a casualty clearing station with forty lorry

loads to close, pack, re-pitch and open in a new place in thirty-six to forty-
eight hours, which means that they carry as essentials all their canvas, Soyer's
stoves for cooking, stretchers, blankets, and fifty beds and mattresses, and
whatever else the O.C. likes to take to bring the total up to forty loads."

This then was in marked contrast to the 100 to 200 lorry-
loads, which had been moving casualty clearing stations in
1916 and 1917, and forms an important basis for estimating
the requirements of moving casualty clearing stations by road.

It will be observed that at the end of the first stage of the
great advance, the Fourth Army situation as regards the
position of its casualty, clearing stations had materially altered.
Vecquemont had become the chief centre, for six casualty
clearing stations had been concentrated there ; not, however,
on the old sites of the Somme battles but on high ground to
the west of the town, about half a mileirom the railway station.

Difficulty had been experienced in getting ambulance
trains up to the new railheads during the operations, as directly
a railhead was opened ammunition and supply trains came
up in a constant stream. It was on account of this difficulty
that so many casualty clearing stations were opened at Vecque-
mont, as it was possible there to load two ambulance trains
at one time, and the pressure of ammunition and supply trains
was over by the time the casualty clearing stations had opened.

No. 18 Advanced Depot of Medical Stores had moved to
the asylum, south of Amiens, but otherwise there was no
change in the position of advanced depots or of motor
ambulance convoys during the advance.

The divisions engaged during this first battle were the 3rd,
1st and 2nd Canadian Divisions, between the Amiens-Roye
and Amiens-Peronne road, with the 4th Canadian Division
and the 3rd, 2nd and 1st Cavalry Divisions passing through ;
the 2nd and 3rd Australian Divisions, between the Amiens-
Peronne road and the Somme, with the 4th and 5th Australian
Divisions passing through ; and the 50th, 18th and 12th
Divisions of the Illrd Corps, between the Somme and the
Ancre. The 32nd Division joined the Canadian Corps on the
10th August and went into the line.

The Canadian Corps divisions formed collecting posts, marked
by a stick and white bandage, instead of regimental aid
posts ; the bearers or horsed ambulance wagons brought the
wounded who were collected by the regiments from these
posts to the advanced dressing stations. The main dressing

THE ADVANCE TO VICTORY 301

stations, as the advance progressed, moved to the advanced
dressing station positions. No attempt was made to pitch
tents or occupy buildings. The weather was fine and the
work of the main dressing station, except on the first day,
could then be carried out in open fields.

The Australian Corps had much fewer casualties than was
anticipated. The D.D.M.S., Colonel Barber, in anticipation
of much larger numbers of wounded, had organized a system
of reserve dressing stations which were to open at specified
points only when ordered to do so by him. His general
arrangements after the advance in the afternoon of 10th
August were to have two main dressing stations, one for the
right and one for the left sector, each receiving casualties from
an advanced dressing station and a divisional collecting post.
A reserve dressing station was ready to open in each sector as
required. There was a light railway between Vecquemont
and Vignacourt and arrangements were made to run trains
of ten trucks, each truck carrying fifteen to twenty lightly
wounded, to the casualty clearing stations at Vignacourt.

A feature in the work of the Australian Corps was the
organization of blood transfusion and resuscitation teams for
work with the field ambulances at the advanced dressing
stations or main dressing station of each division. Until
these were ready, a corps resuscitation team carried on the
work of blood transfusion in suitable cases. Each team
consisted of two officers and four orderlies, specially trained
in the operation.

The divisions of the Illrd Corps, which included the 33rd
American Division, had main dressing stations at Querrieu,
Montigny and Vadencourt, with a corps walking wounded
collecting station at Montigny, for the operations on the
8th August. They were cleared to the casualty clearing
stations at Pernois. Twenty-eight lorries were placed at the
disposal of the D.D.M.S., Colonel Profeit, for sitting cases.
Four divisions were in the line when the attack was made,
the medical situation being as follows : —

Right division (58th) A.D.S. — Smith's Farm, near Querrieu.

W.W.C. Post — Corbie-Mericourt Road, on
the site of the Heilly C.C.Ss. during the
Somme battles of 1916.
M.D.S. — Querrieu.
C.W.W. Station — Montigny Farm.
Right centre (18th) A.D.S. — Bray-Corbie Road, about 1£ miles

division. from Corbie.

W.W.C. Post — As for right division.

M.D.S.

C.W.W. Station

302 MEDICAL HISTORY OF THE WAR

Left centre (12th) A.D.S.— Buire.

division. W.W.C. Post — Sugar Factory, Ribemont.

M.D.S. — Red Chateau, Montigny.
C.W.W. Station — As for right division.

Left division. (47th) A.D.S. — Henencourt Chateau.

W.W.C. Post— Warloy.
M.D.S. — Vadencourt Chateau.
C.W.W. Station — As for right division.

The 66th American Brigade was with the 12th Division,
but had its main dressing station with the 47th Division, and
an independent advanced dressing station and walking wounded
collecting post on the Querrieu- Albert road, the former just
south-east of and the latter south-west of Bresle. The 63rd
and 17th Divisions joined the corps during the operations *

The wounded in the Illrd Corps from 6 a.m. 8th to 6 a.m.
12th August were 190 officers and 3,927 other ranks, of whom
35 per cent, were lying cases, 20 per cent, sitting and 45 per
cent, walking cases. The average time for the return journey
of cars from the main dressing stations to casualty clearing
stations was three hours, and for lorries from the corps walking
wounded stations to casualty clearing stations six hours.

The Battles of the Somme.- — The operations of 21st August
to 3rd September 1918, over the old battle ground of the Somme
and Arras, had no specially new features so far as the medical
situation was concerned, except in their effect on the strategical
positions of the casualty clearing stations. As in the Somme
battles of 1916, corps were constantly changing from one
sector of the front to another and divisions from one corps to
another. Their medical units were consequently subjected to
the same frequent changes, and were employed in accordance
with the general principle of main dressing stations following-
up the advance to advanced dressing station positions and the
latter to regimental aid post positions.

The 1 1 ltd Corps of the Fourth Army received into its medical
units during this period 325 officers and 7,569 other ranks,
of whom 60 per cent, were walking wounded, 30 per cent,
lying down cases and 10 per cent, sitting cases. During the
first twenty-four hours, the average number of casualties in
each division engaged was 800, the proportion of walking
cases being higher, 69 per cent., than during the whole period.
Colonel Profeit, the Corps D.D.M.S., records some interesting

* His Majesty the King, on the 12th August, visited the dressing stations at
Montigny and Querrieu.

THE ADVANCE TO VICTORY 303

and valuable details regarding the clearing of wounded back,
during this period of mobile warfare :■ —

" Except during an exceptional rush of casualties one car of the motor
ambulance convoy every ten minutes at each divisional main dressing station
and one lorry every twenty minutes at each divisional walking wounded
collecting post were sufficient to keep clear. The speed of the lorries was
about six miles per hour and of the cars seven miles per hour "

The estimate of the number of motor ambulance cars
and lorries required was based on these factors and on the
distances between respective medical posts.

The Fourth Army casualty clearing stations receiving the
wounded were the six at Vecquemont No. 47 and No. 48 at
the asylum, Amiens, and No. 49 and Nos. 1 (Canadian) and 4
(Canadian) at Boves were not specially involved, as the opera-
tions were chiefly north of the Summe, but they received a
number of the walking wounded. There was some anxiety
regarding evacuation from Vecquemont on account of delays
in getting ambulance trains up, but in consequence of the
large number of casualty clearing stations there, there was no
great congestion.

By the end of August further movements of the Fourth
Army casualty clearing stations became possible, but owing
to the Third and First Armies being engaged during this period
as well as the Fourth, and to the area previously occupied by
the Canadian Corps having been taken over by the French,
the three casualty clearing stations at Boves were transferred,
No. 49 to the Third Army to Colincamps, and the two Canadian
casualty clearing stations to Pernes in the First Army. No. 4
C.C.S., at Pernois, was also transferred to Colincamps. The
Fourth Army casualty clearing stations were then distributed
as follows by the end of the month. Their new positions
indicate the substantial advance made during the battle : —

Edgehill . . Nos. 47 and 48 from the asylum
and No. 55 from Vecquemont.
Heilly . . No. 20 from Vignacourt.

Proyart . . Nos. 5 and 41 from Vecquemont.

Vecquemont . . Nos. 53, 37 and 61.
Longpre . . No. 12.

No. 41 Stationary Hospital was moved then into the asylum,
at Amiens, from Pont Remy.

Between the 2nd and 18th September the Fourth Army was
not heavily engaged, but during that period a steady advance
was made over ground from which the enemy had withdrawn,

(10134) Z*

304

MEDICAL HISTORY OF THE WAR

and the casualty clearing stations were moved to positions
still further forward. Vecquemont was closed as a casualty
clearing station centre by the 9th September. No. 53 moved
to Peronne la Chapellette, where it was joined by No. 12,
from Longpre, on the 9th September ; No. 37 and No. 61
went to Maricourt Plateau. Edgehill was also closed ; No. 48
CCS. moving on the 12th, and No. 47 on the 16th September
to Brie, south of Peronne and on the east bank of the canal,
and No. 55 on the latter date to Doingt, where No. 20, from
Heilly, had already arrived ; so that before the operations,

No. 118 U.S.A. Field Ambulance at Tincourt during the
Advance to Victory, 1918.

which commenced on the 18th September, the Fourth Army
casualty clearing stations were all at Proyart, Peronne la
Chapellette, Doingt, Brie or Maricourt Plateau.

The Battle of Epehy. — On the 18th September the Fourth
Army again attacked with the Illrd and IXth Corps, and a
further advance was made ; the wounded admitted to the
casualty clearing stations of the army between the 18th and
21st September being 345 officers, 8,359 other ranks, 24 German
officers and 757 German other ranks. The wounded during this
attack were received into the casualty clearing stations at
Brie, Peronne la Chapellette and Doingt. After the fighting
had ceased Proyart was closed as a casualty clearing station
centre, No. 41 CCS. moved to Doingt and No. 5 to Brie.

THE ADVANCE TO VICTORY 305

The casualty clearing stations, Nos. 12 and 53, at Peronne
la Chapellette, on the west of the canal, were also moved
forward to Tincourt, to the old casualty clearing station site
there. Tincourt was also reinforced by two other casualty
clearing stations, Nos. 50 and 58, the former from the L. of C.
and the latter from the Second Army ; so that when the Fourth
Army made its assault on the Hindenburg line on the 29th
September, there were four casualty clearing stations at
Tincourt, three at Brie, three at Doingt, and two on the
Maricourt Plateau.

The Battle of St. Quentin Canal. — The attack on the 29th
September by the Fourth Army was made by the Illrd (12th
and 18th Divisions), Hnd American (37th and 30th Divisions),
Australian (1st, 2nd, 3rd, 4th and 5th Australian Divisions)
and IXth Corps (1st, 6th, 32nd and 46th Divisions), with the
XHIth Corps and Cavalry Corps in support. The distance
of the casualty clearing stations from the front line of attack
was from ten to fourteen miles, Tincourt being the nearest
centre. During the interval between the 21st and 29th
September there had been no operations on a large scale,
although fierce fighting took place at many points of the line
occupied by the Fourth and Third Armies between St. Quentin
and Cambrai. The general assault on the Hindenburg line
in the Fourth Army sector led to stubborn fighting north of
St. Quentin, which continued for several days. The number
of wounded who were admitted to its medical units between
the 29th September and 5th October amounted to 743 officers,
16,863 other ranks, and 50 German officers and 1,262 German
other ranks.

The Battle of Cambrai. — A further advance of casualty
clearing stations of the Fourth Army was now made previous
to a renewal of the attack on the 8th October. Sites for
them had been selected at Bihecourt, on the St. Quentin-
Roisel line of railway, about one mile north of Vermand, and
at Roisel, about three miles east of Tincourt. Nos. 41, 48
and 53 C.C.Ss. were moved to Roisel, and Nos. 5, 47 and 61
to Bihecourt by the 7th October. These formed then the
forward casualty clearing stations with three still at Tincourt,
two at Doingt and one at Maricourt Plateau. Brie ceased to
be a casualty clearing station centre. The railway sidings,
however, at Roisel and Bihecourt were not ready on the day
of the renewed attack, and the casualty clearing stations
there were not opened for wounded on the 8th October. Trains
came up to these places for the first time on the 10th October.

306 MEDICAL HISTORY OF THE WAR

Between the 6th and 12th October the wounded in the Fourth
Army numbered 304 officers, 7,275 other ranks, 22 German
officers and 782 German other ranks.

Battles of the Selle and Sambre. — The next general attack,
in which the Fourth Army was engaged, took place on the
17th October by divisions of the XHIth, Hnd American and
IXth Corps. The most forward railheads for ambulance
trains at the time were Bihecourt and Roisel. The fighting
in open country had now commenced and although the number
of wounded in the Fourth Army then became less as compared
with the previous fighting — numbering some 3,000 to 4,000
weekly until the Armistice — the difficulties of transport were
greater, owing to the rapid advance, the broken nature of
railways and roads in the devastated areas, and the damage
done to them by the retreating enemy.

Between the 17th October and the date of the Armistice
only two more advanced casualty clearing station positions
were opened by the Fourth Army, namely, at Bohain and
Busigny. Nos. 55, 20, 50 and 61 C.C.Ss. went to the former
place between the 19th and 22nd October ; and Nos. 12 and
48 to the latter on the 22nd and 23rd October. Doingt thus
ceased to be a casualty clearing station centre during the last
week of October, and Tincourt was reduced to one casualty
clearing station only, No. 58. Maricourt was vacated on the
2nd November by No. 37 CCS. being moved up to Busigny.

The situation, therefore, of the casualty clearing stations
in the Fourth Army at the time of the Armistice was as
follows : —

At Bohain . . Nos. 20, 50, 55 and 61.

„ Busigny . . Nos. 12, 48 and 37.

,, Bihecourt Nos. 5 and 47.

„ Roisel . . Nos. 41 and 53.

,, Tincourt . . No. 58.

No. 41 Stationary Hospital remained at the asylum, Amiens,
throughout the advance.

Medical Services with the Third Army.

The Third Army became engaged in the active operations
of the advance on the 21st August, after the Fourth Army had
advanced the front to a line from Lihons to Albert. The

THE ADVANCE TO VICTORY

307

Fienvillers

Gezaincourt . .

Frevent

W a vans

Ligny-sur-Canche

Fillievres

Hesdin

Auchy-les-Hesdin

casualty clearing stations of the Third Army were then situated
in the following localities : —

Nos. 34 and 38.

Nos. 3, 29 and 56.

Nos. 19 and 43.

No. 21.

No. 3 Canadian.

No. 46.

No. 59.

No. 45.

The two stationary hospitals, No. 6 at Frevent and No. 3
(Canadian) at Doullens Citadel, had been moved before the
attack. The former was at Fillievres, where it was ready
to receive patients on the 18th August. The latter had been
closed on the 11th August and was at Rouen.

The Battles of A Ibert and Bapaume. — In the fighting which
took place on the Third Army front from Hamel, on the Ancre,
to Moyenneville, between the 21st and 24th August, 529 officers
and 12,746 other ranks, and 38 German officers and 980 German
other ranks were admitted to the Third Army casualty clearing
stations, chiefly to those at Gezaincourt and Frevent. An
advanced operating centre was formed at the main dressing
station of the Vlth Corps at Bac-du-Sud with a surgical team
from No. 46 CCS. In the subsequent fighting 603 officers
and 15,563 other ranks and 45 German officers and 923 German
other ranks were admitted to the Third Army C.C.Ss.
between the 25th and 31st August.

The line had then advanced to beyond Bapaume, and casualty
clearing stations began to move forward. Nos. 45 and 46
were brought up on the 26th August to Bac-du-Sud
(Bailleulval) ; Nos. 4 and 49 from the Fourth Army to Colin-
camps on the 28th and 29th August ; and No. 59 and No. 3
(Canadian) to Varennes at the same time.

The Battle of the Hindenburg Line. — During the fighting
on the Third Army front in September and until the commence-
ment of open fighting the wounded, during periods of attack,
were as follows : —

Offs.

O.R.

Germans.

Offs.

O.R.

Sept. 1st to 7th
Sept. 18th to 21st
Sept. 21st to 28th ..
Sept. 29th to Oct. 5th

390
214
355
306

8,538
5,130
9,155
7,289

907
223
840
389

•308

MEDICAL HISTORY OF THE WAR

The situation of the casualty clearing stations during these
periods was : —

Forward Area.

Middle Area.

Back Area.

For Sept. 1st to 7th

Bac-du-Sud (2)

Fienvillers (2).

Varennes . . (2)

Gezaincourt (2).

Colincamps (2)

Frevent .. (3).
Wavans . . (1).

For Sept. 18th to 21st

Beaulencourt(2)

Varennes . . (2)

GSzainconrt (1).

Grevillers . . (2)

Bac-du-Sud (2)

Wavans . . (1).

Boisleux-au-

Colincamps (2)

Mont (2)

For Sept. 22nd to

Beaulencourt(3)

Varennes . . (2)

Gezaincourt (1).

30th.

Grevillers . . (3)
Boisleux-au-

Mont (2)
Delsaux Farm(l)

Bac-du-Sud (2)

The Final Advance. — Before the Third Army was engaged
on the 8th October and subsequent days in the fighting in
open country, Ytres had been reoccupied as a casualty
clearing station centre. No. 3 (Canadian) came there on the
1st October and No. 18 C C.S. three days later. A second
casualty clearing station (No. 46) was also brought up on the
1st October to Delsaux Farm, south of Beugny, on the Cambrai
road, about five miles east of Bapaume. Consequently,
during the fighting between the 8th and 14th October, which
advanced the Third Army front to Le Cateau over a depth of
some twelve miles, the most forward of the casualty clearing
stations were at Ytres and Delsaux Farm. Ytres was about
twelve miles from the front line on October 7th and twenty-
four miles on October 14th. The remaining casualty clear-
ing stations at Beaulencourt, Grevillers, Boisleux-au-Mont,
Varennes and Gezaincourt were ten to thirty miles still further
back.

The Third Army was again engaged in severe fighting on
the 20th, 23rd and 24th October, pushing its advance on to
Le Quesnoy, some seven miles further, just before this
attack took place, No. 59 CCS. from Varennes and No. 45 from
Bac-du-Sud were moved to a forward position at Awoingt,
south of Cambrai. From Boisleux-au-Mont No. 38 CCS. was
also moved to Awoingt on the 20th October, and on the 23rd
October No. 19 CCS. was brought up to Caudry, where good
buildings were available, half-way between Cambrai and Le
Cateau.

THE ADVANCE TO VICTORY

309

Between the 24th October and the 4th November, when the
operations commenced in the country between Valenciennes
and the Sambre, the number of casualty clearing stations at
Caudry was increased to four by the arrival of No 21 from
Gezaincourt on the 26th October, No. 3 from Beaulencourt on
the 31st October, and No. 49 from Grevillers on the 3rd Novem-
ber. Two casualty clearing stations, No. 4 from Beaulencourt
and No. 34 from Grevillers, were opened at Solesmes in a much
more advanced position during the first three days of November.

No. 3 New Zealand Field Ambulance at Solesmes, 1918.

The number of wounded received into the Third Army
casualty clearing stations during the fighting between the
6th October and 2nd November was as follows : —

Offs.

O.R.

Germans.

Offs. O.R.

Oct. 6th to 12th
Oct. 13th to 19th
Oct. 20th to 26th
Oct. 27th to Nov. 2nd

379
103
443

8,294
2,947
9,953
2,247

35
2

32
9

718
67

762
97

(10134)

310 MEDICAL HISTORY OF THE WAR

No ambulance trains could come up to Cambrai for the
casualty clearing stations at Awoingt. Consequently, on the
25th October wounded had to be carried from Awoingt by
motor ambulance convoys to the casualty clearing stations at
Ytres and Delsaux Farm, or to Beaulencourt and Grevillers, for
evacuation by ambulance train. Evacuation in this way by
road was particularly heavy, ten cars running hourly all day
to Ytres and Delsaux Farm from Awoingt.

On the 3rd November, on the eve of the final operations,
the railway bridge at Caudry was blown up by a delay-action
mine, and no ambulance trains could be run to the casualty
clearing station there. A large number of buses was obtained,
and some twenty were kept for road evacuation from Caudry
to Awoingt and, if necessary, to Delsaux Farm and Ytres.
There was thus considerable trouble in evacuating the casualties
during the fighting of the 4th and 5th November. Ambulance
trains, moreover, were not running well and the number
arriving to clear Awoingt was too few. The buses, owing to
blocks on the road, took much longer on their journeys than
had been usual. Evacuation had consequently to be carried
on continuously by ambulance cars to Ytres and Delsaux
Farm, and by the evening of the 5th November the drivers
were much exhausted.

Owing to the rapidity of the advance between that date
and the Armistice, the casualty clearing stations were left far
behind, but the casualties, fortunately, were comparatively
few. Third Army troops entered Maubeuge on the 9th
November and then active operations ceased.

The wounded of the Third Army between the 3rd and 9th
November were 355 officers and 7,582 other ranks, and 47
German officers and 958 German other ranks. The only
change then made in the casualty clearing stations was to
move No. 3 (Canadian) to Le Quesnoy on the 9th November,
Consequently the situation of casualty clearing stations of
the Third Army at the time of the Armistice was as follows : —
At Solesmes . . . . Nos. 4 and 34.

No. 3 (Canadian).

Nos. 3, 19, 21 and 49

Nos. 38, 45 and 59.

Nos. 46 and 29.

No. 18.

No. 56.

,, Le Quesnoy
,, Caudry . .
,, Awoingt . .
,, Delsaux Farm
,, Ytres
,, Grevillers

Beaulencourt . . No. 43.

THE ADVANCE TO VICTORY 311

Six motor ambulance convoys were allotted to the Third
Army during the various periods of the advance, namely,
Nos. 21, 6, 30, 27, 15 and 16. They were allotted for work
with corps or as Army reserve.

The advanced depots of medical stores in the Army were
No. 15 at Frevent throughout the operations, No. 16 at Wavans,
moving during the operations to Bac-du-Sud (Bailleulval)
and Cambrai, and No. 34 at Gezaincourt and, from the
beginning of October, at Grevillers.

Medical Services with the First Army.

The First Army did not become engaged in the active
operations of the advance until the 26th August. At that
time the situation of its casualty clearing stations was as
follows : —

At Anvin . . . . Nos. 2, 15 and 23.

„ Ligny St. Flochel Nos. 7, 33 and 1.

„ Pernes . . . . Nos. 6, 13 and 22.

„ Wavrans . . No. 30.

„ Mingo val . . Nos. 42 and 57.

No. 12 Stationary Hospital at St. Pol was also under the
First Army administration.

Consequently, the distance from the front line of the most
forward casualty clearing stations at Mingoval, north of
Aubigny, on the 26th August was about twelve miles, and of
those further back some twenty or more miles. The two
casualty clearing stations at Aubigny had been moved to
Mingoval during the earlier part of August in consequence of
their positions near the railway station at Aubigny having
become dangerous from long-distance artillery fire and air raids.
Up to the 25th August the D.M.S. of the Army, Maj. -General
H. Thompson, and his staff had no information regarding the
impending operations. He had gone on leave only three days
before the attack took place, but returned on the 28th August.

The Battles of Arras. — Immediately after the attack was
launched by the First Army on the 26th August, No. 23 CCS.
was moved to the old casualty clearing station site at Agnez-les-
Duisans. The D.M.S. of the Army had continued his policy
of placing his casualty clearing stations under the administra-
tive control of Corps D.Ds.M.S. Consequently, on the 27th
August, responsibility for control of the C.C.Ss. of the Army

(10134) BB

312 MEDICAL HISTORY OF THE WAR

had to be determined, and the D.M.S. issued the following
orders :• —

"To be administered by the VHIth Corps : —

Nos. 1, 7 and 33 C.C.Ss. at Ligny and No. 30 CCS. at Wavrans.
" To be administered by the Canadian Corps : —

Nos. 42' and 57 C.C.Ss. at Mingoval, and any casualty clearing station,
Nos. 23, 1 (Canadian) and 4 (Canadian), moving to or due to arrive
at Agnez-les-Duisans.
" To be administered by the 1st Corps : —

Nos. 6, 13 and 22 C.C.Ss. at Pernes.
"To be administered by the XXIInd Corps : —

Nos. 2 and 15 C.C.Ss. at Anvin."

No. 12 Stationary Hospital at St. Pol remained under the
administration of the D.M.S.

The number of wounded received into the First Army
casualty clearing stations between the 26th and 31st August
was : officers 412, other ranks 9,310, German officers 12, German
other ranks 535.

On the 28th August No. 23 C.C.S., and on 1st September
No. 1 (Canadian) and No. 4 (Canadian) C.C.Ss., arrived at
Agnez-les-Duisans.

The Battle of the Canal du Nord. — The line of the First Army
was advanced to near the Canal du Nord, between the Arras-
Cambrai and Bapaume-Cambrai roads, by the 2nd September,
when there was a lull in the fighting on this front until the
27th September. No further moves of casualty clearing
stations were made until the 12th and 16th September, when
Nos. 6 and 15 C.C.Ss. were moved to Ruitz and placed under
the administration of the 1st Corps D. D.M.S. The Indian
section of the Lucknow CCS. was also attached to No. 6 CCS.
at Ruitz. Later on casualty clearing stations were moved up
on the right of the First Army front to Ficheux and Boisleux-
au-Mont, in an area recently taken over from the Third Army.
Nos. 22, 30 and 33 C.C.Ss. were transferred to this locality
just before the attack of the 27th September against Bourlon
and Cambrai in conjunction with the Third Army. At the
same time the casualty clearing station positions at Ruitz
and Pernes came into the Fifth Army area, and Nos. 13 and
15 C.C.Ss. were then transferred to that Army. No. 6 CCS.,
however, remained at Pernes as a First Army unit.

During the operations of the 27th September and following
days, No. 1 CCS., at Boisleux-au-Mont, acted as a casualty
clearing station for walking wounded ; and Nos. 22, 30 and
33, at Ficheux, as casualty clearing stations for severely
wounded. The wounded were being brought back to the

THE ADVANCE TO VICTORY

313

railway station at Boisleux in closed trucks from Queant on a
broad-gauge line of railway. Boisleux railway station was
only 200 yards from No. 1 CCS. and arrangements were made
there for the lying down wounded to be received and taken
on by road to the casualty clearing stations at Ficheux. In
advance of Queant there was a good network of field railways.
Otherwise the only main route of evacuation which could be
followed was the Arras-Cambrai road, and it was under shell
fire and heavily congested with traffic. Roads south of the
main road were in bad condition and mostly ran north and
and south ; that is to say in a lateral direction and not directly
back from the battle zone.

The Third Army had two casualty clearing stations at this
time also at Boisleux-au-Mont, with a special siding for ambul-
ance trains, but this was not at the disposal of the First Army,
which had consequently to send its lying down wounded to
Ficheux, to be entrained there.

The number of wounded received into medical units of the
First Army during the September operations was as follows : —

Offs.

O.R.

German.

Offs.

O.R.

Sept. 1st to 7th
Sept. 21st to 28th
Sept. 29th to Oct. 5th

491
351
336

10,275
7,276
7,555

44
41

959
725
376

During this period the D.M.S. carried out the policy of
evacuation of wounded direct from advanced dressing stations
to casualty clearing stations without an intermediate main
dressing station ; but what he had in fact abolished was the
advanced dressing station, as the resources of the field am-
bulance tent divisions were concentrated at these dressing
stations. The real advanced dressing stations were the collecting
posts at which wounded were loaded on wheeled conveyances
for transport to the dressing station. Owing to the bad state
of the roads the broad-gauge railway from Queant to Boisleux
was of immense assistance during the advance on Bourlon and
Cambrai.

The Battle of Cambrai.- — On the 9th October the Canadian
Corps on the right of the First Army resumed the attack on
Cambrai in conjunction with the operations of the Third Army,
and advanced to the east of the town with less than 200
casualties. Owing to the rapid advance the D.M.S. of the

314

MEDICAL HISTORY OF THE WAR

First Army immediately ordered up No. 2 CCS. from Anvin
and No. 57 C.C.5. from Mingoval on the following day by rail
to near Queant, which was then the most forward railhead.
Nos. 42 and 7 C.C.Ss. were also ordered to close and be ready
to move from Mingoval and Ligny St. Flochel. These casualty
clearing stations, however, were not moved till much later,
but No. 1 and No. 30 from Boisleux and Ficheux were moved
to buildings at Escaudoeuvres, north-east of Cambrai, on the
18th and 20th October in anticipation of further fighting.

A large civil hospital was in use as a corps rest station at
Cambrai. It was placed under the administration of No. 22
CCS., which was brought up from Ficheux on the 25th October.
At the same time No. 23 CCS. was moved forward from
Agnez-les-Duisans to Brebieres, three miles south-west of
Douai on the Arras road, and No. 42 from Mingoval to Douai ;
both units being accommodated in large buildings. No. 1 and
No. 4 Canadian C.C.Ss. were next selected for transfer from
Agnez-les-Duisans to a more forward area. The former was
transferred to large buildings at Auberchicourt, between Douai
and Valenciennes, and the latter to a large chateau in the Bois
de Montigny about three miles north of Auberchicourt, which
had originally been used as a sanatorium for tubercular diseases.
No. 6 CCS., which had been at Ruitz in the Fifth Army area,
was also moved to the Bois de Montigny at the end of October.

The Final Advance. — During October the First Army did not
suffer many casualties as compared with the Third and Fourth
Armies, with which it was co-operating ; and the strain on its
medical units was not great.

Between the 5th October and 2nd November the number of
wounded received into them was : —

Offs.

O.R.

German.

Offs.

O.R.

Oct. 6th to 12th
Oct. 13th to 19th
Oct. 20th to 26th
Oct. 27th to Nov. 2nd

149
120

143

4,337
3,517
2,191
2,839

4
11

149
42

160
381

The majority of the wounded in the last period were wounded
on the 1st November, when the Canadian and XXI Ind Corps
advanced on Valenciennes. Between then and the date of the
Armistice 118 officers, 2,317 other ranks and 4 German officers
and 105 German other ranks were wounded.

THE ADVANCE TO VICTORY 315

The situation as regards the casualty clearing stations of the
First Army at the time of the Armistice was as follows : —

No. 4 (Canadian) CCS. was opened at the " College des
Jeunes Filles," Valenciennes, for all serious cases of all three
corps of the First Army.

Lighter cases of wounds and sickness were transferred by
motor ambulance convoy from the VHIth Corps to Nos. 6 and
42 C.C.Ss. at Bois de Montigny and Douai ; from the Canadian
Corps to No. 1 (Canadian) CCS., at Auberchicourt, and to
Denain, where No. 33 CCS. had been moved into a large
Technical School ; and from the XXIInd Corps to No. 22 CCS
at Cambrai, and Nos. 1 and 30 at Escaudoeuvres.

Nos. 2 and 57 C.C.Ss., at Queant, were moving to Valen-
ciennes, and No. 23, at Brebieres, was being closed. No. 7
remained in the back area at Ligny St. Flochel. On arrival
at Valenciennes No. 57 CCS. was established in the Convent of
St. Saulve, a suburb of the town, and No. 2 in the " Hospice
des Petites Soeurs des Pauvres " for the reception of French
and Belgian civilian sick and wounded.

No. 8 (Canadian) Stationary Hospital was being brought up
to the Bois de Montigny ; and No. 6 CCS. then moved to a
college in Valenciennes. Nos. 1, 23 and 30 C.C.Ss. were then
ordered to close and remain parked.

Medical Services with the Fifth Army

The Fifth Army was reorganized as such at the end of June
1918 under the command of General Sir W. Birdwood, but it
had no D.M.S., until 22nd July, when Major-General J. J.
Gerrard was appointed. Lieut. -Colonel Boylan Smith, however,
was A.D.M.S., and carried on the administrative duties till
then. Colonel Frankau was appointed consulting surgeon and
Colonel Miller consulting physician.

On the 1st July the Fifth Army took over one of the areas
of the First Army, in the neighbourhood of Aire and Therouanne,
with the Xlth and XHIth Corps. The following medical units
were then in the area : —

Casualty Clearing Stations —
At Aire, Nos. 51 and 54.
At Fines, No. 8.
Motor Ambulance Convoys —

No. 22 at Ferfay with XHIth Corps.
No. 25 at Aire with Xlth Corps.

316 MEDICAL HISTORY OF THE WAR

Mobile Laboratories —

No. 9 (Hygiene) at Therouanne.
No. 20 (Bacteriological) at Aire.
Stationary Hospital —

No. 39 at Fort Gassion, Aire.
No. 43 M.A.C. was added to the medical units as Army
reserve convoy on the 6th July, and No. 32 CCS. on the 10th
July. On the 14th July No. 51 CCS. was moved back from
Aire to Coyecque, four miles south-west of Therouanne. The
general policy during July was in fact to withdraw medical
units from Aire, as they were liable to be shelled and bombed,
and leave only an advanced operating centre in No. 54 CCS.
which had replaced No. 39 Stationary Hospital at Fort Gassion.
Consequently, the medical situation in the Fifth Army at the
time of the British advance was as follows : —
No. 39 Stationary Hospital parked at Desvres.
Nos. 8 and 32 C.C.Ss. . . at Elnes
No. 51 CCS. . . . . at Coyecque.

No. 54 CCS. . . . . at Aire.

No. 1 Advanced Depot of near Elnes at Wavrans sur l'Aa.
Medical Stores.

No. 22 M.A.C with XHIth Corps at Ferfay.

No. 25 M.A.C with Xlth Corps at Fort Gassion,

Aire.
No. 43 M.A.C . . . . as Army Reserve at Clety.

No. 9 (Hygiene) Laboratory at Therouanne.
No. 16 (Bact.) Laboratory at Elnes.
No. 20 (Bact.) Laboratory at Coyecque.
No. 39 (Bact.) Laboratory at Fort Gassion.
A Portuguese division was with the Fifth Army with Nos.
4, 6 and 8 Portuguese field ambulances.

Immediately after the success of the Fourth Army offensive
the D.M.S. of the Fifth Army commenced to move his casualty
clearing stations forward again. He brought No. 32 up to
Lozinghem Chateau, and had it replaced at Elnes by a new
casualty clearing station, No. 63, which had been sent to it
from Senlis after the operations of the British with the French
Groupe d'Armees de Reserve on the Marne.

A second advanced depot of medical stores, No. 31, was also
sent to the Fifth Army and placed at Fort Gassion, Aire.

The Fifth Army, throughout the advance to victory
was engaged in following the enemy in his retreat from
the area between Armentieres and Lens. There was no

THE ADVANCE TO VICTORY

317

serious resistance, and the Army entered Lille in the middle
of October without opposition.

The number of wounded received into its C.C.Ss. during
different periods of its advance was consequently small, as is
shown in the following table : — ■

Germans.

Offs.

O.R.

Offs.

O.R.

Sept. 1st to 7th

804

—

Sept. 21st to 28th

484

—

Sept. 29th to Oct. 5th

1,179

—

Oct. 6th to 12th

629

—

Oct. 13th to 19th ..

658

■ — ■

Oct. 20th to 26th

633

—

Oct. 27th to Nov. 2nd

1,087

—

Nov. 3rd to 9th

1,038

In the middle of September the 1st Corps, in the northern
sector of the First Army, was taken over by the Fifth Army,
and with it one of the casualty clearing stations at Pernes
(No. 13) and one at Ruitz (No. 15 ), together with No. 12 M.A.C.
Two casualty clearing stations of the Second Army, Nos. 1
and 2 (Australian), were also given to the Fifth Army and
placed in St. Venant on the 15th September. Thereafter
the casualty clearing stations followed the advance of the
Army in the following order : —

Date.

CCS.

From.

To.

Oct. 10th . .

No. 13

Pernes

Cambrin.

>> »»

No. 54

Aire

Cambrin.

it >> • •

No. 51

Coyecque

Estaires (Nouveau Monde) .

„ 12th ..

No. 2 Aust.

St. Venant

Estaires (Nouveau Monde).

„ 22nd . .

No. 15

Ruitz

Don.

„ 24th . .

No. 32

Lozinghem

Don.

„ 27th . .

No. 1 Aust.

St. Venant

Fretin.

„ 31st ..

*No. 63

Second Army . .

Lille and Ascq.

No. 13

Cambrin

Ascq.

* Went from Elnes to the Second Army on 13th September and returned
to the Fifth Army on 31st October.

No. 39 Stationary Hospital was moved to the Hopital
St. Sauveur, Lille, on the 27th October from Desvres.

318

MEDICAL HISTORY OF THE WAR

The Fifth Army advanced as far as Ath, and then settled
down after the Armistice in Lille and the neighbouring towns,
the casualty clearing stations being established in buildings in
Tournai, Courtrai, St. Andre and Tourcoing. Nos. 62, 11, 8 and
10 C.C.Ss. were taken over from the Second Army in the last
three towns in situ between the 15th and 17th November.
No. 54, which remained at Cambrin, Nos. 15 and 32 at Don,
Nos. 13 and 63 at Ascq, and No. 51 at Tournai, where it arrived
on the 12th November, were handed over in situ to the First
Army on the 26th November.

Nos. 10, 4, 3 (Canadian) and No. 1 (New Zealand) Stationary
Hospitals also came into the Fifth Army administration from
the Second Army during November. They were respectively
at Tourcoing, Longuenesse (with a section for Chinese at
Moulle), Malassise and Bourg (near Wisques) at that time.

Medical Services with the Second Army

The Second Army advanced rapidly, experiencing much less
serious opposition than the First, Third and Fourth Armies.
Its operations, as already noted, were conducted under the
command of H.M. The King of the Belgians, and its advance
was chiefly over the devastated Ypres Salient, which had been
the scene of so many battles since October 1914. It was,
however, engaged in heavy fighting between the 28th September
and 2nd October, with the Ilnd, XlXth, Xth and XVth Corps
on the Ypres front, and again on the 14th and 19th October at
Courtrai.

The wounded who came into the medical units of the Second
Army during the advance were as follows :■ —

Offs.

O.R.

Germans.

Offs.

O.R.

Sept. 1st to 7th

182

3,564

Sept. 21st to 28th

125

2,658

169

Sept. 29th to Oct. 5th

272

5,822

216

Oct. 6th to 12th

652

Oct. 13th to 19th ..

214

5,129

463

Oct. 20th to 26th

188

3,422

158

Oct. 27th to Nov. 2nd

1,350

154

Nov. 3rd to 9th

424

—

THE ADVANCE TO VICTORY 319

In the first week of August 1918 the D. M.S. of the Army,
Major-General Guise Moores, had his casualty clearing stations
placed as follows : —

Unit.

Locality.

No. 1 (Australian) CCS.

No. 2 „ „

No. 36 CCS

No. 64

Nos. 10 and 44 C.C.Ss

No. 3 (Australian) and No. 2 (Canadian) C.C.Ss.

No. 58 CCS

No. 62

No. 18 „

No. 11 „

Blendecques.

Watt'en.

Near Bergues.

Esquelbecq.

Longuenesse.

Arneke.

Malassise.

Moulle.

No. 1 (Canadian) and No. 4 (Canadian) C.C.Ss. were at
Arneke, but closed, having been sent there, it will be remem-
bered, to divert the enemy's attention from the impending
attack of the Fourth Army. No. 17 CCS. was also with the
Second Army, but was parked at Bourg, near Wisques.

There were three stationary hospitals, No. 10 at Clerques
(near Licques), No. 4 at Arques, and No. 1 (New Zealand) at
Bourg. No. 9 B.R.CS. Voluntary Hospital (Millicent, Duchess
of Sutherland's) was at Longuenesse, but closed.

Advanced depots of medical stores were at Blendecques
(No. 2), Arneke (No. 11) and Esquelbecq (No. 2 Canadian).

The mobile laboratories with the Army were : —
No. 1 (Bact.) with No. 10 CCS. near Bergues.
No. 8 (Bact.) with No. 64 CCS. at Watten.
No. 11 (Bact.) with No. 2 (Australian) CCS. at

Blendecques.
No. 4 (Hygiene) at Bourg.

The motor ambulance convoys were Nos. 2, 4, 5, 14, and 20.
Nos. 4 and 14 were attached to the Ilnd and XVth Corps
respectively. The others were directly under the control of the
D.M.S., with two sections of No. 2 attached to the XlXth
Corps and one of No. 5 to the Xth Corps. There was also
a voluntary convoy of the First Aid Nursing Yeomanry
(F.A.N.Y.) consisting of thirty cars for local duty at St. Omer,
under the A.D.M.S., whose area was then in the Second Army.

In August the Second Army was engaged in minor operations,
during which Oultersteene was occupied on the 18th August
and Bailleul on the 30th of the month. As the enemy was
then retiring preparations were made for moving casualty

320

MEDICAL HISTORY OF THE WAR

clearing stations forward. No. 17, after a trial move with
nine lorry loads to Arneke, was opened there on the 27th
August, but was transferred to Ana Jana Siding on 4th Sep-
tember together with No. 1 (Australian) and No. 2 (Australian)
C CSs. No. 4 Stationary Hospital was, however, being
moved from Arques to Recques in a back area.

At the beginning of September the Ilnd American Corps
went into line with the Second Army, in the Canal and Dicke-
busch sectors, before its transfer to the Fourth Army.

On the 14th and 19th September, No 1 (Australian) and
No. 2 Australian C.C.Ss. left the Second for the Fifth Army,
and were replaced by No. 8 and No. 63 at Ana Jana Siding
and Ebblinghem respectively. There was then a general move
forward of the casualty clearing stations to the old casualty
clearing station sites behind the Ypres salient as follows : —

CCS.

From

No. 36

No. 3 (Australian)

No. 2 (Canadian)

No. 10

No. 62

Watten
Esquelbecq
Esquelbecq
Near Bergues
Arneke

Rousbrugge.

Haringhe (Bandaghem).

Remy Siding.

The moves were made in fifty lorries placed at the disposal
of the D.M.S. for the purpose.

No. 9 B R.C.S. hospital was also permitted at the same
time to move forward to Ana Jana Siding.

Nos. 58 and 18 C.C.Ss. at Longuenesse and Malassise were
closed, preparatory to their being transferred at the end of
the month to the Third Army ; and No. 10 Stationary Hospital
was then ordered to move into the hospital huts at Longuenesse.

The Battle of Ypres. — During the attack and rapid advance
beyond the Messines and Passchendaele ridge between the
27th and 30th September, the conditions affecting evacuation
of wounded in the Second Army became very difficult. There
was incessant rain on the 30th September and the roads on
the Passchendaele ridge were much damaged. Consequently
wounded had to be carried back long distances by hand to
main dressing stations.

After these operations the two casualty clearing stations
furthest back, No. 11 from Moulle and No. 44 from Bergues,
were brought forward to Brielen, near Ypres, on the 6th and
7th October, and No. 36, from Roosbrugge, was also transferred
there a few days later. At the same time No. 3 (Canadian)

THE ADVANCE TO VICTORY

321

Stationary Hospital, which it will be remembered had been
sent from the Citadel, at Doullens, to Rouen on the 18th
August, was brought up to the Second Army area and opened
at Mai assise.

The Battle of Courtrai. — During the whole of the last two
weeks in October, the Second Army continued to make rapid
advances in Belgium, at times against strong resistance, and
by the end of the month had passed through Roubaix,
Tourcoing, Menin and Courtrai, and had reached the line of
the Scheldt. There was consequently a wide area of devas-
tated country between the divisions of the army and the

No. 63 Casualty Clearing Station at Ebblinghem, 1918.

casualty clearing stations across which ambulance transport
by road or rail was for a time extremely difficult. Fortunately
the buildings in towns and villages east of the Passchendaele
ridge had not suffered much damage and were available for
medical units.

No. 8 and No. 17 C.C.Ss. were moved to Les Trois
Tilleuls on the 20th October ; Mouveaux was occupied by
No. 2 (Canadian) CCS. on the 22nd October ; No. 64 and
No. 3 (Australian) C.C.Ss. were moved to Dadizeelehoek on
the 23rd October; No. 11 was moved to St. Andre on the
26th October ; No. 10 to Tourcoing on the 1st November, and
No. 44 to Courtrai (Heule) on the 3rd November. These last
two units were moved by rail from Brielen and Remy Siding.

(10134)

BB*

322 MEDICAL HISTORY OF THE WAR

On the 6th and 7th November, No. 36 CCS. was brought up
to Sweveghem (St. Andre) and No. 17 to Deerlyck (Toureoing) .
The voluntary hospital, No. 9 B.R.C.S., was also brought by
rail into Belgium and placed at Roubaix on the 4th November.

Some further moves took place just before the Armistice,
when the situation of medical units in the Second Army was
as follows : —

Deerlyck . . No. 17 CCS.

Mouveaux . . No. 2 (Canadian) CCS.

Dadizeelehoek . . No. 64 and No. 3 (Australian) C.C.Ss.

Toureoing . . No. 10 CCS.

Sweveghem .. No. 36 CCS. (closed).

Courtrai. . . . No. 44 CCS.

St. Andre .. No. 11 CCS.

Roubaix . . No. 9 B.R.C.S. Hospital (closed).

The stationary hospitals at Longuenesse, Malassise and
Bourg, in the St. Omer area, were transferred in situ to the
Fifth Army. No. 10 Stationary Hospital was, however,
retained by the Second Army, and was transferred to
Arneke on the 9th October. It was brought up to Toureoing,
after the Armistice, on 15th November, and was subsequently
transferred to the Fifth Army area there.

The Medical Situation generally during the Advance.

In reviewing the medical situation generally during the
battles the main features were the large numbers of casualties
in the Fourth and Third Armies and the right of the First
Army ; the comparatively few casualties in the operations of
the Second and Fifth Armies in Flanders, but at the same
time the rapid and extensive advance of these two armies
over the devastated area of the Ypres-Armentieres sectors to
the large towns of France and Belgium beyond ; and the
general handling and management of the casualty clearing
stations and transport to meet these conditions. Another
factor which also came into operation and affected the medical
services was the provision that had to be made for the civilian
populations and released prisoners of war as well as for the
numerous sick and wounded amongst the German prisoners.

The special medical problems of all five Armies were
undoubtedly those of transport. The number of casualty
clearing stations was adequate in all Armies, but they were
from the very commencement much further back than in
previous battles. This handicap was accentuated too by the
rapidity of the advance, especially in the case of the Second

Chart showing daily totals of Admissions to Casualty Clearing Stations of the First, Second/Third, Fourth &
Fifth Armies during "The Advance to Victory 1818

2848C SOeo/m ISOO II.Z3

Heavy iine indicates British .

Light i/ne indicates German.

THE ADVANCE TO VICTORY 323

Army. Motor ambulance convoys and motor ambulance
transport generally were also adequate in numbers ; the num-
ber of convoys was indeed increased at the end of October
by the arrival of No. 47 and No. 48 ; but the damage to the
roads and the general traffic prevented their working as rapidly
and as uninterruptedly as might otherwise have been the
case. They received little or no assistance from light field
railways, although advantage was taken of these in places.
The ambulance trains also ran with less regularity, owing to
delays and damage to railway lines. There were, in fact, at
times long gaps between the more advanced medical units
and the nearest railheads.

It was fortunate, therefore, that the number of wounded in
any one Army on any one day was considerably less than had
been the case in some of the previous battles ; but the
aggregate number of wounded when two or more Armies
were actively fighting at the same time threw a very great
strain on evacuation by ambulance trains. Consequently,
there was an accumulation of wounded in casualty clearing
stations, pending the arrival of the trains, which made the
work in these units particularly arduous. The railheads,
especially in the north, did not advance as rapidly as the troops,
and the question arose whether it was best to push casualty
clearing stations in advance of railheads and have two stages
of road transport through casualty clearing stations to railheads
or to retain the casualty clearing stations at railheads only
and bring the wounded back by one long road journey on cars.
As a rule the latter alternative was adopted, but in that
case advanced operating centres were established, either in
field ambulances or in advanced casualty clearing stations,
for urgent cases and for those unfit for the,long transport back.

Experimental moves of casualty clearing stations were made
in some Armies to test the rapidity with which a casualty
clearing station could be moved and re-establish itself, and
the amount and nature of equipment that it was possible to
carry on nine or more lorries. In one Army, the First, an
officer and twenty-five men of the R.E. were attached to the
D.M.S. staff for engineering work on the site selected for each
new casualty clearing station. They were of the greatest help.

The largest number of wounded received in one day into
casualty clearing stations of an Army was 7,643, on the 8th
August, in the Fourth Army, but as no other Armies were
then engaged this number must be regarded as small in com-
parison with the number of wounded on the first day of the

324 MEDICAL HISTORY OF THE WAR

battles of Loos, in 1915, and the Somme, in 1916. Details of
the wounded received into each Army day by day of the
advance to victory will be found in Appendix C. The
aggregate of wounded day by day in all Armies is shown on
the chart. It will be seen that the maximum was on the
27th, 28th and 29th September. This maximum, however, did
not exceed the maximum on the first days of the battles of
Loos and the Somme.

One of the difficulties which arose in consequence of more
than one Army being engaged at the same time was the difficulty
of providing surgical teams at each of the casualty clearing
stations in sufficient numbers to enable surgical work to be
carried out to the same extent as in the Battles of Ypres in
1917 ; but here again the smaller number of wounded counter-
balanced to some extent the smaller number of surgical teams
available for each Army.

The large number of wounded enemy prisoners added
greatly to the work of the medical units, as may be gathered
from the statistics given above and in the appendix. The
orders were to retain them for treatment in hospitals in France.
The effect of this was to interfere to some extent with the
arrangement by which delayed primary suture of wounds
amongst the British was to be carried out at the base hospitals ;
for, owing to the large number of beds occupied by German
wounded, many of the British wounded had to be evacuated
to the United Kingdom before primary suture was completed.

Although the number of wounded was considerably less
during the fighting in open country in October and November
the work thrown on the medical services was greater than ever.
Influenza of a grave type, with broncho-pneumonia and other
complications, attacked the troops about the middle of October,
and continued till the end of the operations. During the week
ending 2nd November, for example, there were 11,936 admis-
sions, with 625 deaths, from this disease, and during the following
week 11,877 admissions and 878 deaths — figures which show
the extent and gravity of the epidemic.

Another source of strain on the medical services was the
necessity of taking over the medical charge of large numbers
of sick and infirm men, women and children amongst the civil
populations of the liberated towns and villages. Casualty
clearing stations such as No. 2 at Valenciennes were in some
instances allotted for this work alone.

The casualties amongst the personnel of the medical services
from the beginning of the advance to the time of the Armistice

THE ADVANCE TO VICTORY 325

were 64 officers and 249 other ranks killed or died of wounds ;
and 186 officers and 1,667 other ranks wounded. Six other
ranks also were missing.

Of the officers killed or died of wounds 37 belonged to the
R.A.M.C, 7 to the Canadian and 6 to the Australian Army
Medical Corps, 1 to the New Zealand Medical Corps, 1 to the
Royal Navy, and 12 to the U.S.A. Medical Corps.

The Medical Situation after the Armistice.

After the Armistice arrangements were made for the Second
and Fourth Armies, covered by Cavalry Divisions, to advance
into Germany, each army consisting of four corps of four
divisions each. The advance commenced on the 17th November
and progressed by definite stages. The German frontier was
crossed on the 1st December, and then, owing to the narrow
front allotted to the British forces, the Second Army only
continued its advance. It consisted of the Hnd, Vlth, IXth,
and Canadian Corps, with eleven divisions ; the 9th, 29th and
New Zealand in the Ilnd Corps ; the Guards, 2nd and 3rd in the
Vlth Corps ; the 1st, 6th and 62nd in the IXth Corps ; and the
1st Canadian and 2nd Canadian divisions in the Canadian Corps.
Cologne was occupied by cavalry on the 6th December and next
day by infantry brought up by rail. Cavalry crossed the Rhine
on the 12th December and occupied the Cologne bridgehead.
They were followed by columns of infantry who crossed at
Cologne and Bonn. Eventually these towns and Diiren and
Euskirchen were each occupied by a corps of the Army. The
Army headquarters were established at Cologne.

The Fourth Army occupied the liberated territory in Belgium,
with headquarters at Namur. The Cavalry Corps established
its headquarters at Spa, in the Ardennes.

The Fifth, First and Third Armies, with headquarters
respectively at Lille, Valenciennes and Flexicourt (on the
Somme between Abbeville and Amiens), were left to clear up
the devastated areas and administer the vast numbers of labour
corps troops and prisoners of war engaged in that work.

The medical services were called on to make provision for all
of these and for the Armies on and behind the Rhine, as well
as for the large numbers of liberated prisoners, who found their
way to the British lines. Motor ambulance convoys were
sent into the interior of Germany to collect prisoners who
might be unable to move. Detachments of motor ambulance
cars from No. 8 and No. 20 M.A.Cs. in this way explored the
interior up to the Polish frontier. They all returned by 14th
February except one, which had to be abandoned in the snow
at Allenstein in East Prussia.

326

MEDICAL HISTORY OF THE WAR

The general distribution of the casualty clearing stations
and the stationary hospitals in Army areas after the new
positions had been taken up was as follows : —

Second Army. Bonn

Fourth Army.

Third Army.

Cologne . .

Diiren

Euskirchen

Charleroi

Huy

Maubeuge

Namur . .
Nos

Busigny

Cambrai . .

Caudry . .

Doullens . .

Grevillers

Le Quesnoy

Pont Remy

Solesmes . .

Tincourt . .

Fillievres. .

Amiens . .
Nos. 38
Busigny

Nos. 1 (Canadian) and 2 (Canadian)
C.C.Ss.

Nos. 44, 36 and 64 C.C.Ss.

No. 17 CCS.

No. 3 (Australian) CCS.

Nos. 20 and 55 C.C.Ss.

No. 50.

Nos. 5 and 47.
. . No. 48.
61 and 53 at Gembloux and Houyet were closed.
. . Nos. 12 and 37th C.C.Ss.
. . No. 22 CCS.
.. Nos. 19 and 49 C.C.Ss.
.. No. 18 CCS.
. . No. 56 CCS.
. . No. 3 (Canadian) CCS.
. . No. 46 CCS.
.. No. 4 CCS.
. . No. 58 CCS.
. . No. 6 Stationary Hospital.
. . No. 41 Stationary Hospital.
45 and 59 C.C.Ss. at Awoingt, No. 37 at
No. 21 at Caudry, No. 29 at Delsaux Farm,

First Army

No. 41 at Le Cateau, and No. 34 at Solesmes were closed.

Fifth Army.

Agnez-les-D uisans

Ascq

Auberchicourt . .

Bois de Montigny

Denan

Don

Douai

La Louviere

Mons

St. Saulve

Tournai

Valenciennes

Warlus

St. Pol . .

Ath

Courtrai

Hal

Lillers

St. Andre

Tourcoing

Longuenesse
Moulle

Lille
Malassise

No.
No.
No.
No.

No.

7 CCS.
13 CCS.
23 CCS.
6 CCS.
33 CCS.

No. 15 CCS.

No. 42 CCS.

No. 30 CCS.

No. 1 and No. 4 (Canadian) C.C.Ss.

No. 57 CCS.

No. 51 CCS.

Nos. 2 and 32 C.C.Ss.

Lucknow CCS.

No. 12 Stationary Hospital.

No. 2 (Australian) CCS.

No. 62 CCS.

No. 1 (Australian) CCS.

No. 8 Portuguese Field Ambulance.

No. 11 CCS.

Nos. 8 and 10 C.C.Ss. and No. 10

Stationary Hospital.
No. 4 Stationary Hospital.
No. 4 Stationary Hospital (Chinese

Section).
No. 39 Stationary Hospital.
No. 3 (Canadian) Stationary Hospital.

Collecting stations for liberated prisoners of war were formed
by the French immediately after the Armistice at Douai,
Cambrai, Valenciennes, Maubeuge, Lille, Roubaix, Arras and
Amiens in British army areas or lines of communication area,
and for a time the British Medical Services assisted in the work
of these centres.

CHAPTER XVIII.

THE MEDICAL SERVICES WITH THE BRITISH FORCES IN ITALY.

BRITISH medical services were employed in three different
spheres of activity in Italy, namely, on the Mediterranean
Line of Communication between Taranto and Cherbourg ;
with British artillery operating under the Italian command on
the Carso, north of Trieste, until and during the Austrian
offensive of October and November 1917 ; and with the British
Expeditionary Force sent to Italy in November and December
1917 when the Italians had retired to the line of the Piave after
that offensive.

The Mediterranean Line of Communication.

The formation of a Mediterranean Line of Communication, or,
as it was at first designated, an Eastern Line of Communication,
was the first definite organization of a British medical service
in Italy. By the end of 1916 the transport of reinforcements to
and the evacuation of sick and wounded by sea from Macedonia
and Eastern theatres of war were interrupted by the intensive
submarine warfare in the Mediterranean, and in January
1917 the possibility of establishing an overland route between
Taranto and Cherbourg, thus limiting the sea passage to
shorter sea routes from Egypt and Greece to the south of
Italy, was considered at the War Office.

The new line was then reconnoitred in January and February
1917 by a railway and engineer staff, to which an officer of the
R.A.M.C., Colonel J. C. B. Statham, was attached. Colonel
Statham made a second reconnaissance in May 1917 and, after
reporting on its medical and sanitary organization, was immedi-
ately afterwards appointed A.D.M.S. of the Mediterranean
Line of Communication, with headquarters at Lyons. Two
D.A.Ds.M.S., one for the Italian section and one for the French
section of the line, and medical officers for embarkation duties
at Cherbourg and Taranto were appointed to work under him.
In August 1917, the headquarters were transferred to Paris
and control of the line was then taken over by the War Office,
Colonel Statham being graded on the 1st October as a D.D.M.S.

328 MEDICAL HISTORY OF THE WAR

Tented and hutted camps were prepared at Cherbourg,
St. Germain au Mont d'Or (near Lyons), Faenza (near Bologna)
and Taranto, with accommodation for 2,000 men at the first
three camps and for 5,000 at Taranto. Hospitals for 50 beds
were organized at each, except at Taranto, which had a 200-bed
hospital.

At various stations on the line, both in Italy and France,
haltes repas, or rest and refreshment stations, were organized at
four to eight-and-a-half hours' journey intervals in order to
feed the men and give them an opportunity of getting out of
the train. At the camps at Faenza and St. Germain they rested
for four to six hours and were served with a hot meal.

Four sanitary sections were allotted for sanitary work at
the camps and haltes repas : No. Ill Sanitary Section for
Cherbourg and the haltes repas between it and St. Germain,
No. 109 at St. Germain and for the haltes repas between it and
the Italian frontier, No. 110 at Faenza and for the first four
haltes repas in Italy, and No. 112 for the remaining three
haltes repas and the camp at Taranto.

Each halte repas was in charge of a N.C.O. of the sanitary
section and two other ranks. The equipment of a halte repas
consisted of 4 Soyer's stoves, 125 camp kettles, 125 washing
tubs and 150 latrine buckets.

In addition to the British haltes repas there was a series of
French and Italian " infirmeries de gare," or medical stations,
along the line at distances of about 100 kilometres apart,
available to receive any sick unfit to continue the journey.

The total length of the line was approximately 1,400 miles.
The whole of this medical organization, as shown on the
sketch maps, was ready by the end of June 1917.

The requirements in medical personnel were 24 medical
officers, 23 nursing sisters or staff nurses and 247 other ranks.
Medical and surgical supplies were drawn from No. 3 Base
Depot of Medical Stores, Rouen.

At the end of June 1917, when native labour corps began
to arrive at Taranto for duty on the line, additions of fifty beds
for native labour were made to each of the four hospitals.

No. 35 Advanced Depot of Medical Stores was sent to Taranto
and an equipment of medical panniers, reserve dressings and
fracture box was placed on each of the troop trains.

On the Italian sector of the line special arrangements had
to be made in consequence of the prevalence of malaria in its
more southernly portions and in consequence of the diffi-
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MEDICAL SERVICES IN ITALY 329

quinine and at Faenza second water bottles filled with sterilized
water were issued to all troops passing southward of these places.
The water bottles were collected at Taranto and re-issued for
use as far as Faenza by troops proceeding northwards.

A medical officer, Major Mattei of the Australian Army
Medical Corps, who was a Maltese by birth and spoke Italian,
was appointed liaison officer with the Italian medical authorities
and thus obviated difficulties and misunderstanding which
arose at first on the Italian section owing to mutual ignorance
of each other's language on the part of the British and Italian
medical authorities.

These arrangements held good until a British Expeditionary
Force was sent to co-operate with the Italian Army on the
Austrian front, when a new line of communication was formed
between Italy and Marseilles and the medical arrangements of
the Italian section of the line were placed under the D.M.S.
of that force.

But in the meantime Taranto as a base had grown considerably
in size and importance, and in September 1917 it became necess-
ary to expand both the European and native hospitals there to
500 beds each, and to employ five additional sanitary squads.
Segregation camps for both Europeans and natives, and also
a native labour transit camp, were formed. The expanded
European hospital was then designated No. 79 General Hospital,
and the hospital for native labour No. 6 Native Labour Hospital.
No. 79 General Hospital was equipped for 1,100 beds, and there
was, in addition, a small hospital for the British West India
battalions which were on duty there.

The camps at Taranto at that time were organized to
accommodate about 10,000 in huts and tents. Owing to the
prevalence of malaria in the locality all the huts were made
mosquito-proof and mosquito nets were supplied for use in
the tents.

Much difficulty was experienced at first in maintaining a
satisfactory standard of sanitation in these camps, owing to
troops passing through them in large numbers before con-
structions had been completed, but on the whole a high
standard was eventually obtained. Lieut. -Colonel Robertson,
I.M.S., was placed in sanitary and administrative charge,
and Colonel Statham maintained a constant pressure on all
concerned to expedite the necessary works.

The journey from Cherbourg to Taranto usually lasted
two or fnree days, but ambulance trains conveying sick
or wounded coming from eastern theatres of war completed
the journey from Taranto to Cherbourg much more quickly.

(10134) CC

330 MEDICAL HISTORY OF THE WAR

Nos. 39 and 43 Ambulance Trains were employed on this
duty, and proved admirably suitable for carrying sick on
these long journeys. The ordinary trains carrying rein-
forcements were run into sidings to let the ambulance
trains through. Arrangements had been made in the summer
of 1917 to run a weekly service of trains for conveying 500
sick and wounded from Taranto. Two hundred and fifty
were expected to be lying-down cases, and the ambulance
trains were reserved for them. The remaining cases were
carried in special ambulance coaches attached weekly to the
returning troop trains. A large number of these cases were
malaria convalescents or malaria-infected men from Macedonia,
whom it was decided to send to England under what was
designated the " Y " scheme.

Medical Arrangements for British Artillery with the
Italian Army.

While this line of communication was being established,
two groups of British heavy artillery, each of four batteries,
were attached in April and May 1917 to the Italian Third
Army in the Carso area east of the Isonzo. To each of these
batteries a medical officer, N.C.O. and four other ranks
R.A.M.C. were attached. The administrative headquarters
were situated at Gradisca. Major E. F. Eliot, R.A.M.C,
was appointed D.A.D.M.S. for medical administrative duties
and arrived at headquarters on 13th April 1917. He was
invalided in August and was succeeded by Lieut. -Colonel
B. H. V. Dunbar.

A hospital of fifty beds, expanded in May to one hundred
and fifty under canvas, was established at Villa Freifeld, near
Gradisca, under the command of the D.A.D.M.S., and two
groups of two dressing stations each were organized behind
the batteries for the reception of the sick and wounded before
transfer to hospital. The dressing stations were at Doberdo,
Debeli, Pec and Coteci, with a medical officer in charge of
each. A senior medical officer was placed in command of
each of the two groups, and was responsible for the general
medical and sanitary condition of the areas occupied by the
batteries.

Sick and wounded were evacuated from the dressing station to
the hospital by six ambulance cars provided by the British
Red Cross Society in Italy. The British Red Cross Society
also provided equipment for the hospital, and under the
British Ambassador, Sir Ronald Rodd, and Lord Monson,

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MEDICAL SERVICES IN ITALY 331

the British Red Cross Commissioner, helped in a variety of
ways with personnel, equipment and transport to complete
the organization of a medical service for the British artillery.

At first there was no direct line of communication between
Italy and the lines of communication of the British Expedition-
ary Force in France. Several of the British sick and wounded
had to be transferred, consequently, to Italian hospitals, and
R.A.M.C. personnel was detailed for duty in them.

In the middle of May Sir Walter F. Becket, an Englishman
resident in Turin, offered a hospital of fifty beds, which he
was maintaining there, as an auxiliary hospital for British

Italian hospital tent.

casualties. He agreed to provide and maintain the equipment,
the B.R.C.S. in Italy provided the staff, and the Italian
authorities provided rations. The offer was accepted, and
the British authorities agreed to reimburse to the B.R.C.S.
expenditure incurred in payment of the staff. An officer of
the R.A.M.C. was appointed registrar, and a N.C.O., R.A.M.C,
was placed in charge of stores and equipment. The hospital
opened in the early part of June. In the meantime the
hospital at Villa Freifeld, which was within the range of hostile
artillery, was transferred to Versa, about four miles further
back, as some shells had dropped in its vicinity shortly after
it was opened. Ten beds, however, were retained in Villa
Freifeld for sick of the headquarters staff.

(10134) CC*

332 MEDICAL HISTORY OF THE WAR

A point of difficulty arose in connexion with the discharge
of British sick and wounded to duty. According to the
regulations of the Italian army authorities, under whose
command the British artillery was placed, a soldier on dis-
charge from hospital in an " infected " zone had to remain
in a special quarantine hospital for six days before rejoining
his unit. The zone in which the British artillery was operating
was considered an " infected " zone, and it was necessary to
send British sick and wounded to Italian quarantine hospitals
for the six days before discharge. These hospitals were
situated around Bologna, a highly malarious area, and the
D.A.D.M.S. protested against this procedure, on the grounds
that the soldiers ran greater risks of infection there. He
suggested that a certificate signed by the medical officer in
charge of the hospital from which the soldier was being
discharged, declaring him to be free from infectious or other
disease, should be accepted by the Italians in lieu of quarantine,
or, as an alternative, that a convalescent camp might be
established for British soldiers in conjunction with the Versa
hospital, where they might be kept in quarantine for six days
previous to discharge to their units. The Italian authorities,
however, did not agree to this.

Owing to the insufficient number of trained R.A.M.C. with
the British, and the absence of any organized R.A.M.C. unit,
a scheme was submitted to the War Office for personnel to
form a section of a field ambulance and a casualty clearing
station, but the increase of personnel necessary for this was
not sanctioned and the scheme fell through. However, one
matron and ten nursing sisters were posted to the military
hospital at Versa in August, 1917, when the groups of bat-
teries were increased. The number of batteries, however,
was reduced to five in the middle of October.

On the 24th October 1917 the Austrian offensive began, and
lasted till the 18th November, by which date the Italian army
had stabilized its front along the line of the Piave river. On the
26th October the D.A.D.M.S. was warned of its being necessary
to withdraw the hospital at Versa to a site further back. The
nursing sisters were sent off by train to Turin that same after-
noon, and arrangements were made to evacuate the hospital.
The situation on the evening of the 27th had become critical,
and during the night all patients, ten lying and seventy-eight
sitting, were evacuated to Palmanova by eight ambulance cars,
of which the Italians provided five, and in five Italian lorries.
The more valuable equipment was also collected at Palmanova.

MEDICAL SERVICES IN ITALY

333

Early on the 28th October notification was received that the
patients would be entrained at 10 a.m. at San Giorgio di
Nogaro for Turin. All but twenty- three convalescent patients
were got away. The town was now abandoned, some houses
were on fire, and the D.A.D.M.S., with the R.A.M.C. personnel
and convalescents, began a march towards Codroipo. At
San Vito a train was boarded, and all arrived safely at Treviso
some days later, One R.A.M.C. man and three patients were
captured at the Italian hospital at Perteole. With the exception
of equipment and personal kits there were no other losses.

Italian motor ambulance car and service pattern stretcher.

On the 5th November Captain Laing, R.A.M.C, and thirty-
five other ranks were sent to open a temporary hospital in a
villa at Padova. Sick able to travel were transferred from this
hospital to Turin ; others were sent to the nearest Italian
hospital, or to the British hospital now opened at Faenza.

On the 7th November ten guns arrived to take up positions
on the Piave. Two medical officers were with the batteries
and one was with group headquarters. The D.A.D.M.S.
attached two ambulance cars to the group and formed a dressing
station outside Treviso to which casualties were collected
previous to their evacuation to Padova Dressings, stretchers
and first field dressings were obtained from the Italian
authorities.

334

MEDICAL HISTORY OF THE WAR

The Britisli artillery with the Italian army was eventually
absorbed into the British Expeditionary Force, which com-
menced to arrive in Italv at the end of the month.

Italian motor ambulance car.

Medical Services with the British Expeditionary Force

in Italy.

When the Austrian offensive of October and November 1917
forced the Italian troops to withdraw from their positions on
(he Carso east of the Isonzo river to the line of the Piave, a
British and a French expeditionary force were sent from
France to Italy to reinforce the Italian field armies.

MEDICAL SERVICES IN ITALY 335

The British force consisted of the XlVth Corps, with the
23rd, 41st and 7th Divisions, the XI th Corps, with the 5th and
48th Divisions, and various corps, army and line of communi-
cation troops. It absorbed, as just noted, the British artillery
that had been operating with the Italian Third Army, and also
the Italian section of the Mediterranean L. of C.

Previous to the arrival of the British Expeditionary Force
the routes of approach and lines of communication from and
to France, and the areas which the force would occupy in Italy,
were reconnoitred and reports were furnished on the medical
and sanitary aspects of a campaign in Italy by Colonel F.
Newland, then D.D.M.S. of the XVth Corps, who had been
selected for transfer to the XlVth Corps, and by Lieut. -Colonel
S. L. Cummins, both of whom had been specially detailed to do
so in anticipation of the move of the troops. It was decided
to adopt a new line of communication by the coast route from
Marseilles to Genoa, leaving, however, the Mediterranean line of
communication undisturbed, as it was to be used by a similar
force of French divisions. Haltes repas, as in the case of the
latter, were formed along the route of movement of the troops
from Amiens through Dijon to Lyons and thence to Genoa by
Marseilles and Ventimiglia.

A base for the force was formed at Arquata, some twenty
miles north of Genoa on the main line of railway to Alessandria
and the large cities in the north-west of Italy. Lieut. -Colonel
S. L. Cummins was then appointed A.D.M.S. of the Base, and
Colonel F. R. Newland, with the rank of Surg.-General, D.M.S.
of the Force. Colonel Whaite, who had replaced him as
D.D.M.S. of the XVth Corps, was brought back to the XlVth
Corps as its D.D.M.S.

A General Headquarters was formed of the headquarters
staff of the Second Army from France, and the British forces
in Italy came thus under the command of General Sir H.
Plumer. Lieut. -Colonel Chopping and Captain Coplans, the
A.D.M.S. and D. A. D.M.S. (Sanitation) of the Second Army,
remained in these appointments on the staff of the D.M.S. in
Italy ; Surg.-General R. Porter, the D.M.S. of the Second
Army, accompanied the staff to Italy, but was due to retire
shortly afterwards under the age clause, and, as Surg.-General
Newland had already been appointed D.M.S. in Italy by
the War Office, he returned to France immediately after
his arrival.

The lines of communication in Italy between the front and
the base were under an Inspector-General of Communications,

336 MEDICAL HISTORY OF THE WAR

Lieut. -General Sir H. M. Lawson, appointed on the 15th
November 1917. He made Mantova his headquarters at first,
but moved in December to Tortona, some fifteen miles north of
Arquata and twelve miles east of Alessandria. He had no
administrative medical staff with him at first, and Lieut.-
Colonel Cummins acted as a D.D.M.S. of the L. of C. as well as
A.D.M.S., Base, until the arrival of Colonel J. V. Forrest as
D.D.M.S., L. of C, on the 24th December 1917.

The lines of communication were then divided into two areas,
the Base area, which included Genoa and Bordighera, and the
Cremona area, which stretched from Mantova to Turin. The
lines of communication command also extended to the Italian
section of the Mediterranean L. of C, which, as shown on the
sketch map, was also divided into two areas, the Faenza area,
from Castellamare to Modane, and the Taranto Base area, from
Castellamare to Taranto.

Major C. H. Furnivall, who had been D.A.D.M.S. under
Colonel Statham of the Italian section of the Mediterranean
L. of C, was appointed D.A.D.M.S. to Colonel Forrest on the
19th January, with Captain J. D. Wells as a D.A.D.M.S. for
ambulance trains. No sanitary officer was sanctioned, however,
for administrative sanitary duties on the lines of communication,
and, in consequence, the headquarters of No. 110 Sanitary
Section were transferred from Faenza to Tortona, in order that
its commanding officer might act as sanitary officer on the
staff of the D.D.M.S., L. of C, in addition to his other duties.

Although numerous sanitary problems arose in connexion
with the new line of communication areas, the appointment
of a separate administrative sanitary officer on the staff of the
D.D.M.S. was for some reason or other not approved.

The field forces commenced to reach Italy early in November
1917. The headquarters staff of the XlVth Corps arrived in
Milan from France on the 1st of the month. They moved
to Pavia on the 2nd and to Mantova on the 8th November.
The 41st and 23rd Divisions were concentrating on the 17th
November in the neighbourhood of Mantova, and moved
on the 23rd November to a forward area in the neighbourhood
of Vicenza, while the 7th Division was due to arrive in a
back area between Verona and Montagnana, the latter town
becoming railhead for the corps. The headquarters of the
corps then moved to Lonigo, in a central position between
Verona and Montagnana. The corps relieved the 1st Italian
Corps on the Piave at the beginning of December. The 41st
and 23rd Divisions went into the line on the 1st and 2nd of

MEDICAL SERVICES IN ITALY 337

the month from Nervesa to Ciano, about twelve miles north of
Treviso, and some twenty-five miles north of Venice, while
the 7th Division, on the 3rd December, relieved an Italian
division in the reserve area. They formed part of a mixed
British, French and Italian Force under Sir H. Plumer.

The Xlth Corps headquarters arrived at Mantova on the
2nd December. Its two divisions, the 5th and 48th, were to
move to a front astride the river Brenta in the neighbourhood
of Tezze and Marostica respectively, some twenty-four miles
north of Padova. They formed part of a mixed Italian,
French and British Force under General Duchesne of the
French Tenth Army.

The British artillery groups were attached to this corps.

The British divisions remained in these positions throughout
the winter, but there were no active operations.

In March 1918 the disposition of the British divisions was
altered. Sir H. Plumer and his staff, the Xlth Corps head-
quarters staff and the 5th and 41st Divisions returned to
France, and the XlVth Corps, now composed of the 7th, 23rd
and 48th Divisions, was concentrated near Vicenza and took
over the sector on the Asiago plateau from Sculazzon to Penna.
Lord Cavan, who commanded the XlVth Corps, then became
General Officer Commanding-in-Chief the British Force in
Italy.

The XlVth Corps as such was abolished and its headquarters
became 1st echelon G.H.Q. of the force, with a 2nd echelon
for directorates of administrative services at Montebello. A
definite organization of the administrative medical services
with G.H.p. was then authorized by the War Office, to consist
of a D.M.Sf, D.D.M.S., A.D.M.S., D.A.D.M.S., and D.A.D.M.S..
(Sanitary). Colonel Whaite, who had been D.D.M.S., of the
XlVth Corps, remained as D.D.M.S. with the 1st echelon,
representing there Surg.-General Newland, the D.M.S., who
established his office at Vicenza. A D.A.D.M.S. was added to
the staff to assist Colonel Whaite.

The new front on the Asia.go plateau was at first held by
the 23rd and 7th Divisions with the 48th in reserve. In May
the 11th Italian Division was added to the force on the Asiago
plateau under Lord Cavan.

Outline of the Operations.

The Asiago front was attacked by the enemy on the 15th
June 1918, but the British casualties were comparatively slight.
This was followed by a raid on the enemy trenches by British

(10134) dd

338 MEDICAL HISTORY OF THE WAR

divisions on the 9th August, during which one of the R.A.M.C.
officers, Captain W. H. Lister, was killed. The 23rd and
48th Divisions again raided the enemy's trenches on the
27th August, and two more raids were made on the 10th
September.

At the end of September the 23rd and 7th Divisions were
withdrawn from the Asiago front, leaving only the 48th Division
in line there. The two former divisions moved in the middle
of October to an area south of Treviso and west of the Treviso-
Venice road, and went into line on the Piave in front of Treviso.
The XlVth Corps then came into being again with Colonel
Whaite as its D.D.M.S., while Lord Cavan assumed command
of the Tenth Italian Army, which now included the British
XlVth Corps. The 48th Division, however, remained under
the Italian command on the Asiago front. Lord Cavan's
army, in conjunction with the Third Italian Army on its right
and the Eighth Italian Army on its left, attacked the enemy
on the Piave front between the 23rd October and 4th November
1918. The 7th and 23rd British Divisions were engaged. The
48th Division was also engaged between the 29th October and
4th November on the Asiago front. The operations were
continued by the British divisions in association with the
Italian and French divisions both on the Piave and the Asiago
front until hostilities ceased on the 4th November.

The British divisions then were withdrawn from their front
lines and concentrated in an area west of Vicenza by the
middle of November. Detachments were sent on the 22nd
November 1918 to Fiume and on the 28th November to the
neighbourhood of Innsbruck.

Demobilization commenced in December. A medical
mission of a detachment of the 1/lst South Midland Field
Ambulance was sent to Austria. The D.M.S., Surg.-General
Newland, remained in Italy till the end of February 1919,
directing the work of the demobilization of the medical services.

The Medical Arrangements.

When the British divisions commenced to arrive in Italy,
much difficulty was experienced in obtaining suitable positions
for the casualty clearing stations, and for establishing a line
of evacuation from them to the base. There was no difficulty,
however, in obtaining suitable buildings and accommodation
for the base hospitals on the lines of communication at Genoa
and Bordighera. Cremona was considered the most suitable

MEDICAL SERVICES IN ITALY 339

position for an advanced hospital centre, similar to the hospital
centre established at St. Omer in France. It was on the line
of the British retreat in the event of the enemy breaking
through, and it was felt that should heavy casualties occur,
its position would shorten the journey of ambulance trains to
and from the front, as wounded could be unloaded there
while base hospitals were being cleared to France. It was
also sufficiently near the front to allow of motor ambulance
convoys taking wounded there direct from the field ambulances
in the event of casualty clearing stations being obliged to
close and retire.

Some opposition was made to the British establishing hospitals
in Cremona, but the difficulties were overcome, and No. 29
Stationary Hospital from Salonika was in full working order
there, with accommodation for 600. by the beginning of Decem-
ber. No. 30 Stationary Hospital from Salonika was also
opened at Cremona shortly afterwards. At the same time
No. 11 General Hospital and No. 38 Stationary Hospital from
France were established in Genoa, and Nos. 62 and 66 General
Hospitals from Salonika in Bordighera. No. 51 Stationary
Hospital, which mobilized in Malta, did not come to Italy
until the beginning of 1918. It was divided into three sections,
two were opened at Genoa, one for local sick and another for
infectious diseases, and the third section acted as a station
hospital at Arquata, the base headquarters.

A convalescent depot, mobilized at Rouen, was also sent
to Arquata at the end of November, but it was transferred to
Genoa in January.

At Marseilles No. 57 General Hospital from Boulogne,
No. 81 from Malta, and a convalescent depot were opened at
the end of 1917 and beginning of 1918 for the reception of sick
and wounded evacuated from Italy.

A line of communication was thus established, with the main
hospital centres at Genoa and Bordighera receiving casualties
from front areas through Cremona and evacuating them to
Marseilles. This arrangement held good throughout the
occupation of an Italian front by British troops, the only changes
being the return of No. 66 General Hospital to Salonika in
April 1918, and the acquisition of the Becket Red Cross
Hospital in Turin by the British military authorities in the
same month. No. 66 was not replaced, but No. 62 General
Hospital was expanded by taking over its site and equipment,
so that there was no loss of hospital beds. The Turin hospital
became a section of No. 29 Stationary Hospital at Cremona.

340 MEDICAL HISTORY OF THE WAR

The selection of strategical positions for the casualty clearing
stations proved difficult at first, and some anxiety was felt
lest suitable arrangements should not be ready if the enemy
made a determined attempt to break through immediately
after the line on the Piave and Brenta had been taken up by
the XlVth and Xlth Corps.

During the period of concentration, Nos. 9 and 38 C.C.Ss.
were opened in buildings at Canneto and in a hospital at
Mantova, respectively ; but. they were sent to Montagnana,
the railhead of the XlVth Corps, midway between Padova
and Mantova, and opened there between the 25th and 29th
November.

Nos. 24 and 39 C.C.Ss., on arrival in Italy, remained parked
at Citadella, on the railway line between Vicenza and Treviso,
ready to move forward when the British troops took over a
front line. Istrana, some twelve miles west of Treviso, was then
selected as the best strategical position for casualty clearing
stations, and Nos. 24 and 39 C.C.Ss. were placed there early in
December.

The fifth casualty clearing station, No. 37, came to Italy
in the beginning of December and went to Padova, where it
opened in a hospital building, but, as the Italian authorities
were desirous of removing medical units from the city, it
was transferred in January to a villa, about two miles south
of Padova, where it remained until its return to France in
April 1918.

This disposition of casualty clearing stations was suitable
for operations on the Piave front, but did not satisfy the
requirements of the divisions on the Brenta. Consequently
Nos. 38 and 9 C.C.Ss. were removed from Montagnana in
January, the former to Barina, on the left bank of the Brenta,
just west of Citadella, where it opened under canvas, and the
latter to Cavazzale. Until they were ready, sick and wounded
of the Xlth Corps were sent to No. 37 CCS. at Padova.

The accommodation in No. 38 CCS. at Barina was for 250
only in marquees, but a number of huts was to be sent there
for this casualty clearing station by the Italian authorities.
The marquees, owing to the intense cold of January and to
the lack of coal, were far from comfortable. They were heated
by oil stoves, and patients were retained in them as short a
time as possible, evacuation being arranged to take place by
ambulance trains every second or third day. The huts arrived
on the 14th January, but, owing to the projected move of the
Xlth Corps from the Brenta positions to a position at Arcade

MAP OF POSITIONS OF CASUALTY CLEARING STATIONS QN THE ITALIAN FRONT.

50 Miles

CCS. positions during the occupation of
the. Montello Front February 1917.
CCS, positions during the occupation oF
the Asiago Front (May -Sept. 1918)

CCS. positions during the Fistal operat
oF October -November 1918.

im * Approx. Front Line Summer & Autumn 1918.

jiConeqliano M ^^r d D |V
British XtV Corps position / * Jr 00

>^_ December 1917, J ^P

Caste/fr

^ Camposampiero

Montebelluna

s £fy Mardilay

Montebello

Mirano
N?
39

) Lonigo

Montagnana

yENlCE

GULF

OF
VENICE

Malby*Sons.Lith.

MEDICAL SERVICES IN ITALY 341

on the right of the XlVth Corps on the Piave, they were
not erected at Barina. No. 38 CCS. moved at the end of
the month to Paese, half-way between Istrana and Treviso.
No. 9 CCS. was also moved from Cavazzale to Paese at the
same time.

The positions of the casualty clearing stations consequently
at the beginning of February were as shown on the sketch
map.

When the Xlth Corps was withdrawn from Italy Nos. 38
and 37 C.C.Ss. returned to France with it, and the remaining
casualty clearing stations were then moved to positions behind
the new front on the Asiago plateau.

Nos. 24 and 39 C.C.Ss. were opened at Montecchio-Precalcino
and No. 9 at Dueville. Both of these positions are close together
about seven miles north of Vicenza, and between eighteen to
twenty miles from the front line. They were on the plains,
just south of the mountainous region leading to the Asiago
plateau.

The positions of the three casualty clearing stations then
remained unchanged until just before the final offensive on the
Piave at the end of October, when the 7th and 23rd Divisions
returned to the Piave front. No. 39 C CS. was then moved to
Mirano, six miles west of Mestre, and No. 9 to Martellago,
some six miles north-west of Mestre. Both of these towns
were some twenty miles distant from the Piave front, but
advanced operating centres were thrown out close behind the
line. No. 24 CCS. remained at Montecchio-Precalcino for the
reception of casualties from the 48th Division, which remained
on the Asiago front.

After hostilities had ceased No. 9 CCS. returned to Dueville
and No. 39 was withdrawn to Vicenza, so that at the end of
1918 the distribution of the casualty clearing stations was : —

At Dueville No. 9.

At Montecchio-Precalcino . . . . No. 24.
At Vicenza No. 39.

The advanced depots of medical stores were No. 32 from
France and Nos. 35 and 36 from England. No. 35 had arrived
in August and went to Taranto, where it remained. No. 32
was opened at Montagnana at the end of November 1917, but
in February 1918 it was sent to Camposampiero, a railway
junction eighteen miles north of Padova, and at the end of
April to Vicenza, where it remained till the end of the year.
No. 36 Advanced Depot was at Istrana from December 1917 to
April 1918, when it moved to Thiene, behind the Asiago front

342 MEDICAL HISTORY OF THE WAR

and eighteen miles north of Vicenza. At the end of October it
was transferred to the Piave front and opened at Treviso.

The Base Depot of Medical Stores, No. 14, was a new unit
from England. It arrived in Genoa on the 1st December 1917
and remained there.

Of the four mobile laboratories allotted 1 to the British force,
all of which came from France, No. 7 (Bacteriological) and
No. 15 (Hygiene) accompanied the casualty clearing stations,
while No. 14 (Bacteriological) and No. 23 (Hygiene) were
placed at Genoa and Cremona respectively.

Three motor ambulance convoys accompanied the British
force to Italy, two from France, Nos. 26 and 36, and one,
No. 41, from England. A fourth convoy, No. 42, had been
prepared in England for Italy and was to have been sent there
in the latter part of February, but owing to the reduction of the
divisions there and the military situation on the Western Front
it was retained in France. No. 26 M.A.C. was placed at the
disposal of the XlVth Corps. No. 36 went to the Xlth Corps,
but for a time had a section detached for duty at the base,
where it was assisted at the end of 1917 by twenty cars from
the British Red Cross Society. No. 41 M.A.C. did not arrive
till towards the end of January 1918. It was retained as a
G.H.Q. reserve.

The work of the motor ambulance convoys and the motor
ambulance cars of the field' ambulances was affected by the
move of the British line to the Asiago plateau, where the country
was Alpine in character. The roads in places had hairpin
bends and steep gradients and were in places dangerous.
Light vehicles were the most suitable, but most of the cars
were too heavy for the work. Some, however, could negotiate
the bends, but much trouble was caused by overheating of the
engines during climbing. In view, consequently, of the neces-
sity of depending largely on pack transport, a reorganization of
the transport of the field ambulances became necessary, and
experiments as to the most suitable form of ambulance car
were conducted by .Colonel Blackham, the A.D.M.S. of the
23rd Division. The Ford cars were brought to the plateau and
remained there. For work on the mountain roads back from
the plateau the motor ambulance cars with the less powerful
engines were exchanged for those with greater power and large
radiators. The Italian Fiat cars were the best for this purpose,
and authority was received from the War Office for the purchase
of fifty Fiat cars with a body similar to that used in the hills
by the Italians. The body was of thin metal, with doors at the

MEDICAL SITUATION IN THE BRITISH XIV COR PS ON THE ASIACO FRONT IN JUNE 1918.

\Asiago

+ Regmntl. Aid Post.
• Ambulance CarColleciing Post.
Q Advanced Dressing Station.

S Main Dressing Station.
£± Corps Walking Wounded.

Co//ecting Post.
*)L Advanced Operative. Centre
Motor Ambulance. Convoy
__ Approximate Front Line
Div/sional Boundaries .

Conco

Sa/cedo

MaJbyASons.Lith

MEDICAL SERVICES IN ITALY

343

back, and carried six lying-down patients. The authority to form
a convoy with Fiat cars was not received, however, till October,
and the convoy had not been formed when hostilities ceased.

Considerable dislocation of the motor ambulance convoys
took place in order to exchange their more powerful cars with
the less powerful cars of the field ambulances, on which most
of the hill work was thrown. Consequently, No. 26 M.A.C. was
withdrawn to Genoa in April 1918, where it remained working
at the base until the end of the year. No. 41 also was sent to
Genoa during the greater part of the time when the Asiago
plateau was held by the British, leaving No. 36, with the more
suitable cars, as the one convoy working in the forward area.
No. 41 returned to the forward area, with its headquarters
at Thiene, at the end of July. During the October operations
No. 36 worked on the Piave front and No. 41 on the Asiago front.

The Austrian Offensive of ISth to 24th June.

The Austrian offensive in the summer of 1918 was launched
on a front of some ninety miles from the river Astico to the sea.
The British forces were engaged on the 15th and 16th June,
mainly on the Asiago plateau, north of the line Conco-Congollo.
The 23rd and 48th Divisions were holding this position, with
the 7th Division in reserve. Although the enemy penetrated
the 48th Division front to a depth of about 1,000 yards on the
15th June, counter-attacks were delivered in the evening, and
on the following day the original line was restored. Raids
were made by troops of the 23rd Division on the night of
the 21st/22nd June, and normal conditions existed on the
British front by the 24th June.

The weather on the 15th June was warm and sunny.

The casualties admitted to the casualty clearing stations and
evacuated from them during these operations were as follows : —

Date.

Admitted.

Evacuated.

Sick.

Wounded.

Sick.

Wounded.

15th-16th

349

864

802

16th-17th

302

204

176

17th-18th

314

18th- 19th

277

19th-20th

226

156

20th-21st

240

163

21st-22nd

208

22nd-23rd

198

107

23rd-24th

210

—

Total

2,324

1,192

842

1,108

344 MEDICAL HISTORY OF THE WAR

The large number of sick was due to an outbreak of
influenza at the time.

The enemy used a considerable number of lachrymatory and
cyanogen bromide gas shells, but the casualties from these
were comparatively few.

As compared with the battles on the Western Front, therefore,
the work of the medical units was easy, but they had to contend
with the difficulties inherent in operations in mountainous
country.

The 23rd Division A.D.M.S., Colonel W. Croly, had organ-
ized his field ambulances to work on two sectors, right and left.
The right sector had two regimental aid posts, clearing by hand
carriage to a divisional collecting post on the San Sisto road,
and thence by motor ambulance car to an advanced dressing
station at Pria dell'Acqua. The left sector had also two
regimental aid posts, with hand carriage to a collecting post,
and motor ambulance transport thence to an advanced dressing
station at Capitello. The regimental aid posts were in a cave
and in Italian dugouts. There was no congestion in them at
any time ; but the roads from them and from the collecting
posts were rendered impassable to wheeled transport by the
heavy barrages and by fallen trees. The wounded had conse-
quently to be carried by hand for a considerable distance to the
Val del Barenthal road on the right and to bearer posts on a.
new line on the left. The road to Capitello was, however,
cleared and repaired by the afternoon of the 15th and the
original line of evacuation restored.

The advanced dressing stations were heavily shelled on the
morning of the 15th June, but at no time was there any delay
in clearing the wounded.

The main dressing station was at Granezza. The walking
wounded continued to arrive at it up till noon, and after
that hour the stretcher cases came in steadily. In the afternoon
there was some congestion at Granezza, owing mainly to an
insufficient number of motor ambulance convoy cars coming
up, but evacuation proceeded normally when a circuit of cars
had been established. Granezza was heavily shelled during the
morning of the 15th June. It was a crowded locality, and the
D.M.S. instructed the A.D.M.S. on the 19th June to seek a
more suitable place for his main dressing station.*

There were some casualties amongst the R.A.M.C. of the
division, one man of No. 70 Field Ambulance being killed

* In August a new dressing station was opened in seven Italian huts at
Case di Mazze, in place of Granezza.

MedicalSituation in the 48 th Division During
the Austrian offensive of 15 th Junb 1918

AovAkNceo
Dressing 3tatiqn

^Reqimental
M/0 Post

Bearer or
Relay Post

MEDICAL SERVICES IN ITALY

345

and one dying of wounds. An officer, Captain R. Craig,
in medical charge of the 11th Northumberland Fusiliers,
and nine men of the field ambulances were wounded.

Amongst the wounded collected by No. 70 Field Ambulance
there were 144 Austrian and 12 Italian wounded, 122 of the
former and 7 of the latter being stretcher cases.

The 48th division A.D.M.S., Colonel Pickard, established
right and left lines of evacuation from the regimental aid
posts to a main dressing station at Casa di Sunio. On the

Main dressing station at Casa di Sunio.

right, wounded were brought back by hand from two regi-
mental aid posts to an advanced dressing station at Boscon ;
thence by motor ambulance cars to Casa di Sunio. On the
left, the regimental aid posts were cleared to Cesuna either
by hand or by Ford cars from Cavrari. At Cesuna they were
transferred to the heavier cars and taken through Casa
Magnaboschi to the main dressing station. When the enemy
penetrated the line, the regimental aid posts in the centre
were withdrawn, the more seriously wounded having to be
left behind in the retirement, while the regimental aid posts
on the right and left held their positions. The road from

(10134)

346

MEDICAL HISTORY OF THE WAR

the advanced dressing station at Boscon was destroyed at
one place and a large artillery dump exploded, interrupting
traffic for some three hours. The advanced dressing station
consequently had to be kept clear by hand carriage, but no
congestion occurred, reinforcements of bearers being sent up
from time to time. The road was sufficiently repaired for
cars to go up to Boscon advanced dressing station by 10 a.m.
on the 16th June

" Swiss Cottage." Advanced dressing station at Boscon, Asiago Front 1918.

The division had to deal with a large number of sick, owing
to the influenza epidemic. The empty returning lorries were
used to evacuate them. On the second day many Austrian
wounded had been left behind in the counter-attack. They
were also sent back in lorries to the casualty clearing station.

The sketch maps of the front positions of the medical
posts of the 48th Division show how they were affected
by the penetration of the line by the enemy on the morning
of 15th June.

The casualty clearing stations, as already noted, were at
Montecchio-Precalcino (Nos. 24 and 39) and at Dueville
(No. 9). No 36 M.A.C. was employed in clearing to them.
Its headquarters were at Madonetta.

MEDICAL SERVICES IN ITALY

347

348 MEDICAL HISTORY OF THE WAR

One of the field ambulances of the 1th Division in reserve,
No. 21, formed a walking wounded collecting station for the
23rd and 48th Divisions in school buildings at Calvene. The
other field ambulances of the division were employed as a
divisional rest station and hospital for sick, but a section of
No. 22 was employed in an advanced operating centre at
Cavaletto.

A convalescent camp for influenza cases was established
by the 48th Division field ambulances at Tavola (Madonetta)
and a scabies hospital and divisional rest station at Grumolo
Pedemonte. The 23rd Division had a divisional rest station
at Salcedo.

The Battle of Vittorio Veneto.
The Passage of the Piave.
(23rd October to 4th November 1918.)

During the final operations on the Italian front the British
divisions, as already noted, were engaged on two sectors ;
the 7th and 23rd Divisions in the Italian Tenth Army, under
Lord C avan, on the Piave, east of the Treviso-Conegliano
railway ; and the 48th Division on the Asiago front and in
the Val d'Assa, to the north-west of Asiago.

The operations conducted by the former two divisions
were the Passage of the Piave, and by the latter division the
fighting in the Val d'Assa.

In the operations, which commenced on the Piave on the
night of the 23rd/24th October and culminated in the armistice
with Austria on the 4th November, the 7th Division was on the
British right and the 23rd Division on its left, on the right
bank of the river facing the island, Grave di Papadopoli.

The first phase of the attack was the capture of the island
by a brigade of the 7th Division and a battalion of the 23rd
Division on the night of the 23rd/24th October. The troops
crossed over by boats and bridges to the Lido, or northern
end of the island, captured the island and many prisoners,
and then withdrew to their original positions, leaving a holding
party on the island. The main attack was to take place on
the following night, but it rained heavily during the 24th and
the river rose. The operations were consequently postponed
till the morning of the 27th October. Both divisions crossed
to the left bank that day and advanced between then and the
1st November to the Monticano and Livenza rivers. The
23rd Division then remained in the area around Sacile on the

MEDICAL SERVICES IN ITALY

349

Livenza, while the 7th Division advanced to the Tagliamento,
an Italian division having taken its place on the right of the
23rd Division.

The Medical Services during the Passage of the Piave.

At the commencement of the battle the 7th Division had
an advanced dressing station at Maserada and the 23rd at
Lovadina. A corps lightly wounded dressing station was

Ward in an advanced operating centre in Italy.

opened at Limbraga, on the main road north of Treviso, and
an advanced operating centre, with teams from Nos. 9 and
39 C.CSs., somewhat further forward at Carita, on the same
road No. 9 CCS. was opened at Martellago for wounded
only and No. 39 CCS. for influenza patients and other sick.
Field ambulance motor cars evacuated casualties to the ad-
vanced operating centre and lightly wounded dressing station,
and No. 36 M.A.C cleared these to the casualty clearing
station. No. 36 Advanced Depot of Medical Stores was then
at Thiene. Dumps of stretchers and blankets were kept at
Limbraga, and also at the advanced dressing station.

350

MEDICAL HISTORY OF THE WAR

The field ambulances of both the 7th and 23rd Divisions had
been divided into " A " and " B " echelons. Their transport
had been reorganized for work in the mountains on the Asiago
front, as already noted, and had pack transport, G.S. and light
(cavalry pattern) horsed ambulance wagons added to it. "A"
echelon was consequently formed of the bearer divisions with
one tent sub-division each and the light transport ; " B "
echelon of the remainder of the units and the heavy transport.

Operating theatre at an advanced operating centre in Italy.

During the initial operation by the 7th Division on the
night of the 23rd/24th October, a small detachment of "A"
echelon of No. 22 Field Ambulance, consisting of a bearer
sub-division and two medical officers, each bearer taking with
him a stretcher, a blanket and a quantity of surgical dressings,
crossed to the island in boats with the brigade. The crossing
was difficult owing to the darkness. The boats held only
seven men each and the current was strong. The casualties
were few and were successfully got back to the mainland in the
empty boats. They were transferred in ambulance cars to the
23rd Division advanced dressing station at Lovadina. In spite
of the heavy shelling there were no casualties during the

MEDICAL SERVICES IN ITALY 351

transit. The detachment left on the island was in danger of
being cut off from supplies when the river rose in flood the next
day, but extra rations and medical supplies, stretchers and
blankets were got across.

During the main operations, collecting posts were formed by
both divisions on the left bank of the Piave, and the advanced
dressing stations followed in echelons the advance of the
brigades. None of the wheeled transport, however, could be got
across until later, when only the light horsed ambulance
wagons and Ford ambulance cars arrived on the left bank.
They were not, however, permitted to return loaded across the
river. Consequently for a time the evacuation of wounded had
to be carried on by relays of stretcher bearers with the aid of
wheeled stretcher carriers. Both divisions had reinforced the
number of stretcher bearers by 150 men from the infantry and
divisional employment companies, and twenty mule leaders
were attached to each field ambulance for the pack transport.

For the first three days after crossing the Piave it was found
extremely difficult to maintain an adequate supply of stretchers
and blankets. The position was relieved when the Ford
motor ambulance cars crossed the river, but there was no other
source of supply until Sacile was reached. Then a large
quantity of dressings was found there in the hospitals aban-
doned by the Austrians.*

As the Italian division moved into the area of the 7th
Division, orders were given to the A.D.M.S. of the latter on the
morning of the 28th October to take its wounded into his
advanced dressing stations. They were to be evacuated from
there in Italian ambulance cars, but, as only three cars arrived,
most of the evacuation of Italian wounded to their own hospitals
was carried out by the British ambulance cars. A large number
of Austrian wounded was also collected and evacuated

The steadily increasing distance from the river bank made
evacuation by wheeled traffic more and more urgent The
light horsed ambulance wagons came over first, and relieved
the situation to some extent ; but it was only when the motor
ambulance cars reached the left bank of the river that material
assistance was obtained. Fortunately the casualties were not
excessive, and Austrian prisoners assisted in the work of carry-
ing them back. The assistance of the Austrian prisoners,

* No. 36 Advanced Depot of Medical Stores had not arrived at Treviso until
the 30th October, and motor ambulance cars had to be sent back to Thiene
and Vicenza to obtain supplies, thus using up ambulance transport required
for evacuating wounded to the casualty clearing stations near Mestre.

352

MEDICAL HISTORY OF THE WAR

however, led to difficulty in obtaining stretchers, as the prisoners
did not return, and the stretchers taken back by them did not
again come up, at any rate immediately.

Large numbers of bearers had to be kept constantly on duty
carrying wounded across the river by hand. In carrying
from the left bank to the island the bearers had to wade at
times waist deep. The general system of evacuation from the
collecting posts in the most advanced situations to the advanced
dressing station at Lovadina on the right bank of the Piave
is well illustrated by the sketch map taken from the diary of
Colonel W. G. Wright, the A.D.M.S. of the 23rd Division, and
the system of hand carriage across the Piave to the advanced
dressing station at Maserada by a similar sketch map from the
diary of the A.D.MS, of the 7th Division, Colonel S. A. Archer.

Medical Situation of the 23 r -° Division during the final

OPERATIONS ON THE PlAVE,OcT. 1918.

Conegliano.

n Ma/w Dressja/gStat/om or

" /te»^««4?Tifi»S oe-/\A.
O AOVAWCEO £>RESS/A/G STA.
• CoLLECT/NG &OST.

*- Searer relay posy.

Method of Evacuation.

Ma/vo Carriage.
• Haa/o carr/age &>

horse aafecjla/vces.
L/ghtcars *t Morse ames
>H£AVV ameuljwce cars.

OF MILES.
3 4- 5

— I 1 »-

MEDICAL SERVICES IN ITALY 353

Until Sacile was occupied by medical units there were no
suitable means of retaining wounded in the area east of the
Piave, and all had to be transferred to the area west of the
river, but by the 31st October a main dressing station and
advanced operating centre were opened at Borgo Villa, where
there had been an Austrian medical post with ample accom-
modation, by No. 71 Field Ambulance and No. 9 CCS., and
on the 2nd November an advanced operating centre of No. 39
CCS. was moved into the Austrian hospital in the elementary
school at Sacile.*

At the time of the armistice the D.M.S. had arranged with
the D.D.M.S., XlVth Corps to assume responsibility for the
evacuation of casualties from the left bank of the Piave, and
100 Austrian prisoners, under the direction of two officers and
several N.COs. of the R.A.M.C, were employed in this duty.
The casualties could only be evacuated from the left to the right
bank by hand carriage throughout the operations, and this, as
already shown, was effected by relays of bearers. The distance
across the river by the Salettuol Bridge was two miles. An
advanced section of No. 9 CCS. was at Lovadina on the 4th
November, and the evacuation across the river was placed
under the direction of its commanding officer. The ambulance
cars were not allowed to return across the pontoon bridges
till the 6th November. The relays of bearers were then
withdrawn.

The situation, therefore, at the time of the armistice showed
the field ambulances of the 7th Division in the Tagliamento
area, those of the 23rd Division in the Livenza area, advanced
sections of No. 39 CCS. at Sacile and of No. 9 CCS. at
Lovadina, with advanced operating centres at Sacile, Borgo
Villa and Carita, and their headquarters still far back in the
vicinity of Mestre. Evacuation to the base was taking place by
ambulance train from Mestre. No. 36 Advanced Depot of
Medical Stores was at Treviso, and No. 36 M.A.C was engaged
in evacuating casualties from the right bank of the Piave to the
casualty clearing stations and ambulance trains.

On the 9th November the British divisions commenced to
withdraw to the areas around Vicenza.

* There were three Austrian hospitals in Sacile. They had been left intact.
In one, the civil hospital, there were many cases of typhoid fever and influenza.
The elementary school had been used as an operating centre. Only unburied
dead had been left in it. In the third there were a number of Austrian and
one British wounded and influenza cases, under the charge of an Austrian
medical officer and two sisters. None of the hospitals, however, had food or
comforts, and the rest of the staffs of all had been withdrawn.

(10134) FF

354

MEDICAL HISTORY OF THE WAR

The total number of casualties admitted to the medical units
of the XlVth Corps between the 26th October and 1st November
was 2,518, distributed as shown in the following table : —

Formations.

Advanced Operat-
ing Centres.

Lightly Wounded
Dressing Stations.

Grand
Total.

Offs.

O.R.

Total.

Offs.

O.R.

Total.

7th Division
23rd Division
Other formations
Italians
Austrians

6
6
2
1
13

Ill

122

117

128

102

5
20

392
607
9
608
458

397
627
16
608
471

514
755
22
654
573

Totals

371

399

2,074

2,119

2,518

The Fighting in the Val d'Assa.
(29th October to 4th November 1918.)

The operations in which the 48th Division was engaged
while the 7th and 23rd Divisions were thus advancing across
the Piave to the Tagliamento commenced in the Asiago area
with a bombardment of the enemy trenches and a raid by a
battalion in the early morning of the 29th October. The
trenches were found empty, the enemy apparently having
withdrawn to the north of Asiago. The divisional front then
advanced to Camporovere, and attacked the hills north of
Asiago on the east of the Val d'Assa, on the morning of the
1st November. The enemy retired during the night of lst/2nd
November to the Val d'Assa, and an advance along the Val
d'Assa was ordered, with advanced guards occupying the hills on
either side. On the morning of the 3rd November an enemy
corps headquarters and portions of two divisions were sur-
rounded near Vezzena in the valley and over 7,000 prisoners
taken. The 48th Division then occupied the towns of Caldonazzo
and Levico in the Val Sugana (on the Brenta river), and the
armistice was signed the following day. The division was
withdrawn to the plains on the 10th November.

The general arrangements for the medical services were
similar to those during the fighting on the Asiago front in June
1918. The wounded were few, but there were many sick.

No. 24 CCS. remained at Montecchio-Precalcino in the
plains, and had a detachment forming an advanced operating
centre at Cavalletto on the plateau. An advanced dressing
station was at San Sisto and the main dressing station at

MEDICAL SERVICES IN ITALY

355

Mazze, to which it had been withdrawn from Granezza after
the operations in June. The regimental aid posts remained
along the line Camporovere to Asiago until the 2nd November.
When the division advanced along the Val d'Assa on that

day, an advanced dressing station was opened by the l/2nd
South Midland Field Ambulance in an admirably equipped
Austrian medical unit in the valley, and another post was
opened by the l/3rd South Midland Field Ambulance at Asiago.

356 MEDICAL HISTORY OF THE WAR

On the 3rd November the main dressing station was moved up
to the position of the advanced dressing station in the valley,
and the advanced dressing station moved forward to an
Austrian bakery near Vezzena. When the armistice was signed
the A.D.M.S. of the division went on to Caldonazzo and took
over an Austrian hospital, which had accommodation for about
150 on beds or mattresses in two large buildings. The l/2nd
South Midland Field Ambulance was then ordered up to it.
Afterwards sick and wounded were collected to Caldonazzo.
They were all cleared to No. 24 CCS. at Montecchio-Precalcino
by the 14th November. On the 16th November the A.D.M.S.
of the 48th Division was sent to Innsbruck in search of British
sick and wounded prisoners of war. He returned on the 23rd
November with twelve.

The Lines of Communication.

The organization of the lines of communication from the
British front in Italy to the base hospitals at Genoa and
Bordighera, and thence to the Marseilles base in France, has
already been described. No material changes were made during
the time the British forces were in Italy. But before the
organization had been built up and the hospital units from
France and Salonika arrived, the officer commanding No. 79
General Hospital at Taranto was directed to send the equip-
ment for 500 beds with such personnel as could be spared to
Arquata. A hospital for 200 beds was rapidly organized there
in a disused wine factory with this equipment and was known
as the Station Hospital, Arquata, until it was taken over as
" B " section of No. 51 Stationary Hospital. Officers and men
of the R.A.M.C who had been attached to the groups of artillery
were at the same time employed in forming medical and sanitary
posts along the route by which the troops were arriving in
Italy. At Ventimiglia, for example, they established a small
detention hospital, and at Savona a large halte repas.

A consulting surgeon, Colonel T. Crisp English, and a
consulting physician, Colonel H. H. Tooth, were appointed
for duty on the lines of communication and took up their head-
quarters at Genoa. The former left in June and the latter
in October 1918. Colonel English was not replaced, but
Colonel G. R. Murray replaced Colonel Tooth. On the D.M.S.
staff there were also a consulting surgeon, Colonel Gordon
Watson, who came with the staff of the Second Army from
France, and a consulting physician, Lieut. -Colonel Gates.

MEDICAL SERVICES IN ITALY

357

The hospital accommodation at Marseilles and number of beds
occupied at the end of each month are shown on the chart.

CHART SHOWING THE NUMBER. OF HOSPITAL B E1DS AT MARSEILLES BASE
FOR THE BRITISH FORCES IN ITALY

TOP LINE = TOTAL NUMBER OF BED* BOTTOM LINE = NUMBER OF OCCUPIED BEDS
SHABEtl PORTION = VAf.AIMT BEOS

NUMBER

Of BEOS

NUMBER
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Accommodation at the base in Italy was organized on the
same lines as in France, that is to say, expansion in emergency
was provided for by crisis accommodation, and beds were set
apart for special diseases, and for officers, nursing sisters and
labour units, as shown on the next page.

General service V.A.D. women were employed in the hospitals
after August 1918. Before then authority was obtained for
the employment of Italian women. Women drivers from
England were employed at the base for motor ambulance
cars. Hostels were opened for nursing sisters at Taranto,
Rome, Turin and Genoa, more especially for nursing sisters
passing to and from Salonika. A convalescent home was
also established for them at first in Turin, but towards the
end of 1918 in a villa at San Remo. The convalescent home
at Turin was then appropriated for general service members
of the V.A.D.

In July 1918 the Kulm Hotel at Portofino, near Genoa,
was acquired as a convalescent home for officers. It had
accommodation for sixty-eight. Previous to this an American
citizen, Mr. Hagemeyer, offered accommodation for four
officers in his house at Florence. It was used mainly by
officers who had been left sick at Faenza on their way to or
from Taranto.

358

MEDICAL HISTORY OF THE WAR

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MEDICAL SERVICES IN ITALY 359

The convalescent depot for other ranks at Genoa has already
been noted. It was on the sea front at the Lido.

In the establishment of all these units great assistance was
obtained from the branch of the British Red Cross Society in
Italy, under Lord Monson. Until No. 41 M.A.C. arrived,
ambulance cars were supplied by the society for work at
Bordighera, Cremona, Arquata and Tortona. It also formed
depots of stores at Genoa, Taranto, Padova and Vicenza, and
erected a recreation hut at the men's convalescent depot, in
addition to other valuable assistance, such as the provision of
personnel for detention hospitals and invalid kitchens.

The work of the sanitary services in Italy is described in the
volumes on the Hygiene of the War. The most important
duties falling on them were in connection with malaria, which
was specially prevalent in Taranto, as also in the plains south
of the front areas occupied by the British troops.

With regard to ambulance trains, owing to the time taken
on the return journey from front to base and back, a matter
of at least three days, it was felt that in the event of active
operations the four trains attached to the British Expeditionary
Force would not be sufficient. Consequently early in June
1918 provision was made for the preparation of four temporary
ambulance trains. The equipment was collected at an ambu-
lance train supply store at Voghera, and sent as required on
empty ambulance trains to the forward area. A crew of one
medical officer and nine other ranks was detailed for duty on
each. They were brought into use during the final operations,
and were formed of 1st and 2nd class Italian rolling stock
with a kitchen coach added ; 750 to 850 sitting patients could
be carried in each. In connexion with them rest stations
and haltes repas were formed at Cremona and Voghera. They
off-loaded at Genoa.

A further provision of temporary ambulance trains was
made for carrying sitting patients between Genoa and Mar-
seilles. The haltes repas at Savona and Ventimiglia were
used by them, the journey to Marseilles taking twenty-four
hours. No. 10 Italian Red Cross train was also employed in
evacuating patients from Genoa and Bordighera to Marseilles,
running three days in each week. One of the Italian Maltese
Order trains was also lent on one occasion to bring patients
from Mestre to Bordighera. The loading stations in the
forward area were at Mestre for the Piave front and Cavazzale
for the Asiago front.

360 MEDICAL HISTORY OF THE WAR

The arrangements made for evacuating from the Italian
base hospitals to Marseilles met all requirements, although
at one time, in May, the A.D.M.S. of the Italian Base expressed
anxiety regarding the small number of vacant beds reported
from Marseilles. Sick and wounded in the Marseilles hospitals,
however, could always be cleared when necessary to the
northern bases in France, and there was no real cause for
anxiety. The state of vacant beds in Italy and Marseilles
and the number awaiting evacuation from the former is
shown in the chart, from which it will be seen that when
the number of vacant beds in Marseilles in May was low the
number in Italy was high. The only period of much congestion
in both places was after the armistice, at a time when the
urgency of evacuation was not so great.

The Health of the Troops.

The battle casualties, as will have been gathered, were
comparatively few, and, consequently, the greater part of the
work of the medical services, apart from sanitation, was
connected with sickness. The weekly wastage from sickness,
however, was never excessive until October and November
1918, when it increased to an alarming extent on account of
the epidemic of influenza. An outbreak of this disease had
already occurred in May and was continued in June, but
appeared to have abated in July. At first it was thought to
be sand-fly fever, and Lieut. -Colonel P. J. Marett, R.A.M.C,
an expert in this disease, was ordered from France by the
War Office to investigate it. A convalescent camp was
established for the patients at Grumolo by a field ambulance
of the 48th Division. Lieut-Colonel Marett reported that the
disease was not sand-fly fever, although no very clear indication
of its nature was elicited at the time.

When it recurred in October it was definitely of the nature
of influenza, and this disease was the cause of most of the
admissions to casualty clearing stations during the time the
British were in Italy. During the thirteen months ending
December 1918, 10,590 cases had been admitted. The ad-
missions for no other disease approached this figure ; inflamma-
tion of the connective tissue and diarrhoea, which was
specially prevalent in August, only giving 3,727 and 3,485
admissions respectively, and pyrexia of uncertain origin 2,754.
The admissions for venereal disease during the^eriod were 1 ,490.
and no other disease reached the 1,000 figure. Admissions for
frost bite and trench foot were negligible, 26 in all.

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MEDICAL SERVICES IN ITALY 361

The British troops were fairly free from the typhoid group
of fevers in Italy, although it was prevalent in the civil
population and the Italian army in August, September and
October. During the year December 1917 to November 1918
there were thirty cases of typhoid and one hundred and twenty
paratyphoid and other fevers of the enteric group amongst
the British. Fully one-third of these cases occurred early
in the year, when the number of men inoculated against typhoid
was comparatively small. A conference of Italian, French
and British military and Italian civil medical authorities met
in Padua in January 1918, at the instigation of the British
D.M.S. to consider the most suitable measures for combating
the spread of infection, and for organizing co-operation be-
tween the Italian civil authorities and those of the Allied
forces in improving the general sanitation of the occupied areas.
The incidence of typhoid fever amongst the civil population
in the autumn of 1918 was almost half that in the autumn of
1917, apparently in consequence of the measures agreed upon
at this conference.

There was little else of special significance in connexion
with the medical services of the British Force in Italy.

CHAPTER XIX.

THE MEDICAL SERVICES IN EGYPT.

DURING the war Egypt was not only organized for internal
defence but also became the base for the military operations
on its own frontiers and in the Dardanelles, Macedonia and
Palestine. It was also an intermediate base for troops passing
to and from the other theatres of war in Asia, East Africa and
Western Europe. Its eastern frontier ran from Rafa to
Akaba, and included the Sinai Peninsula. Its western frontier
ran from an outpost at Solium, on the Mediterranean littoral,
southwards to the Sudan, and included the oases of Siwa,
Baharia, Farafra, Dakhla and Kharga in the great Libyan
desert which lies between Egypt and Tripoli. On the south
was the Sudan, under a British administration, with its head-
quarters at Khartum, where were also the headquarters of the
Egyptian Army.

The British garrison previous to the war consisted of a
regiment of cavalry, a battery of artillery, an Indian mountain
battery, five battalions of infantry and companies or detach-
ments of R.E., A.S.C., R.A.M.C, A.O.C., and A.V.C., under
the command of Major-General the Hon. J. H. C. Byng. Its
headquarters were in Cairo. The troops occupied the Kasr-el-
Nil barracks there, cantonments in Abbassia, just outside and
north-east of Cairo, and cantonments in Mustapha, on the
sea north-east of Alexandria with detachments in Alexandria.
There were also detachments of British troops in Khartum
and in Cyprus. The Egyptian Army, under the Sirdar,
General Sir Reginald Wingate, was distributed to various
posts in Egypt, the Sudan and Sinai.

The medical services were administered by a D.D.M.S.,
Colonel N. Manders. The R.A.M.C. establishment was 20
officers, including 2 quartermasters, and No. 33 Company (about
116 other ranks) who were distributed to hospitals in Cairo,
Alexandria, Khartum and Cyprus, and to reception hospitals
or detention wards in the Kasr- el-Nil barracks and in the
cantonments at Mustapha. The principal hospital was in
the old palace of the Citadel, Cairo, equipped for 200 beds,

MEDICAL SERVICES IN EGYPT 363

but capable of expansion by stores held in reserve to 543 or
more. The other hospitals were for 100 beds at Ras-el-Tin,
Alexandria, for 70 at Khartum, and for 16 beds in Polymedia
and Troodos, in Cyprus, the former of these two places being
occupied in winter and the latter in summer. At Abbassia
there was a small hospital under a sub-assistant surgeon of
the I.S.M.D. for the Indian establishment of the mountain
battery. A Soldiers' Families Hospital was in the Citadel.
Seventeen members of the Q.A.I.M.N.S. were in the Command,
distributed to the hospitals in Cairo, Alexandria and Khartum.

The Egyptian Army had two modern hospitals of 200 beds
each, one at Abbassia and the other at Khartum. They were
under the administration of a principal medical officer, Lieut. -
Colonel H. A. Bray, R.A.M.C.

There was a large command depot of medical stores in the
Citadel, Cairo.

After war was declared the British units were practically
all withdrawn to help in the formation in the United Kingdom
of the 27th and 28th Divisions. They were replaced by the
42nd (East Lancashire) Division of the Territorial Force,
and Lieut. -General Sir J. Maxwell then replaced Major-General
Byng as Commander-in-Chief of the forces in Egypt.

Until it was decided, in March 1915, to send an expeditionary
force to the Dardanelles, the chief military concern was the
organization of the defence of the Suez Canal. The Turks
had entered the Sinai Peninsula and were threatening an
attack on the Canal. As a temporary measure a brigade of
the Lahore Division on its way from India to France landed
in Egypt on the 9th November 1914, and remained there till
the 19th when it was relieved by an expeditionary force from
India under Major-General A. Wilson, who arrived on the
16th November. The Indian units were then formed into
two new divisions, the 10th and 11th Indian Divisions, and
the Canal defences were organized in three sections, No. 1
with headquarters at Suez, No. 2 with headquarters at Ismailia
Ferry, and No. 3 with headquarters at Kantara. Major-General
Wilson's headquarters were at Ismailia, his advanced base at
Zagazig, and base at Cairo.

In the meantime the 1st Australian Division and the Com-
posite Australian and New Zealand Division arrived in Egypt,
the former early in December 1914, and the latter early in
January 1915. They were encamped respectively at Mena,
some five miles south-west, and at Heliopolis, some five miles
north-east, of Cairo.

364 MEDICAL HISTORY OF THE WAR

When the Expeditionary Force for the Dardanelles was
formed a base was established for it in the area between
Alexandria and Aboukir. It became eventually, in December
1915, the Levant Base under Major-General Altham. It
formed part of the Mediterranean Expeditionary Force Com-
mand, which was independent of the Egyptian Command,
thus creating a dual control in Egypt. The two divisions
from Australia and New Zealand were transferred to this
base, previous to embarkation for the Dardanelles, where
they formed the Anzac Corps. Other divisions from England,
the 63rd (R.N.) and the 29th, also occupied camps there for
a short time in March and April, and the 52nd (Lowland)
Division in June 1915, previous to embarking for the Dar-
danelles. In November 1915 the 28th Division from France
was also temporarily encamped there previous to going to
Salonika. The Levant Base also became a large Base
Depot for reinforcements and supplies to the Mediterranean
Expeditionary Force. It ceased to exist in March 1916.

The military operations in Egypt, until the beginning
of 1916, were confined to patrol work and repelling raids
by the enemy on the Canal, and to extensive operations on
the western frontier of Egypt. Most of the raids on the
Canal were of a minor character, but on the 3rd February
a determined attempt was made to cross the Canal at Toussum
south of Ismailia, between the Great Bitter Lake and Lake
Timsah, and at other points. Enemy camps within striking
distance of the Canal were attacked by mobile columns from
Egypt, especially on the 23rd March and 28th and 29th April.

Various Yeomanry units from the United Kingdom, mounted
troops from Australia and New Zealand, the Bikanir Camel
Corps, and an Imperial Service Cavalry Brigade from India
came to Egypt during this early period.

On the western frontier the followers of the Senussi com-
menced to threaten the Nile delta from the western desert
and extensive military operations had to be undertaken to
safeguard the Nile valley and delta from attacks from the
west between November 1915 and April 1916. On the 5th
and 7th November 1915, the crews of a British naval ship
and transport which had been torpedoed landed on the coast
of Cyrenaica, and were held prisoners by the followers of the
Senussi, who then attacked the frontier post at Solium. The
post was withdrawn to Mersa Matruh, halfway between
Alexandria and Solium, and a force, the Western Frontier
Force, concentrated there under Major-General M. G. Wallace.

MAP OF EGYPT

SHOWING AREAS OF OPERATIONS
SCALE
100

Ra/'/ways shown

MalbyiSonti.Litli

MEDICAL SERVICES IN EGYPT 365

At the same time a Southern Force, under Major-General Sir
John Adye, was engaged in defensive operations against
threatened attacks from the Baharia oasis. The Dakhla and
Kharga oases were at that time occupied by the enemy and
Sir John Adye's force was employed on patrol duty from
Fayum to Assiut and Esna on the Nile.

The campaign against the followers of the Senussi came to
an end in March 1916, and the Southern and Western Frontier
Forces were then combined in one command as the Western
Force. Minor operations continued to be conducted by it for
re-establishing Egyptian rule in the oases and protecting the
western frontier. The Kharga oasis was re-occupied on 15th
April and a garrison of 1,660 established there. The Moghara
oasis was fortified on 27th April, raids were made from Solium
to destroy enemy ammunition dumps on the 7th, 11th, 23rd
and 30th April. The construction of railways towards Baharia
and Kharga was undertaken, and block-houses and patrols
on camels and in motor-cars were maintained to prevent access
to the Nile valley and delta. A thousand miles of front had
thus to be watched on the west. The Baharia and Dakhla
oases were occupied in October 1916 and Farafra in November,
permanent garrisons being placed in them. Siwa oasis was
entered from Matruh by armoured cars on 5th February 1917
with slight opposition.

While these events were taking place, operations were
conducted from the Sudan against the Sultan of Darfur. A
mobile column of some 3,000 in strength, under Lieut.-Colonel
P. V. Kelly, was assembled in March 1916, and during the
following two months traversed a waterless desert for 300
miles west of the railhead at El Obeid. Mechanical and camel
transport was employed on sections of the advance. On May
22nd, a battle was fought at Beringia near El Fasher with
the loss of 5 other ranks killed or died of wounds, and 3 officers
and 18 other ranks wounded. El Fasher was occupied on the
following day. The operations then ceased, but, although not
marked by any outstanding incident, this short campaign
was remarkable for the manner in which the difficulties of
moving columns for so many miles in the desert were
overcome.

When the expeditionary force was withdrawn from the
Dardanelles to Egypt at the end of 1915 and beginning of
1916 and reorganized there as the Egyptian Expeditionary
Force, a command, independent of the command of the forces
in Egypt, was established for the defence of the Suez Canal

366 MEDICAL HISTORY OF THE WAR

and the protection of Egypt from attacks by the Turks. Sir A.
Murray, who took over this command from Sir C. Monro on
the 9th January 1916, had under him all the organized forma-
tions east of a line drawn about five miles west of and parallel
to the Suez Canal, generally speaking the area of the Sharquia
Province of Egypt. The first step was the reorganization
and equipment of a mass of unabsorbed Australian and other
reinforcements at the Levant Base, the organization of
mechanical and other transport, and the formation of training
centres with a view to an offensive defence. The G.H.Q..
of the command was at Ismailia. A mobile force with riding
and transport camels was formed for an advance from Kantara
towards Katia and El Arish. The scheme of operations was
to concentrate at Katia for an advance to positions east of
it- and construct a broad gauge railway and road for the advance ;
as also a pipe-line for supply of water from the Sweet Water
Canal at Ismailia.

On the 19th March 1916, Sir J. Maxwell left Egypt. Sir A.
Murray formally took over the whole command in Egypt and
the dual control then ceased to exist. The staff was reorgan-
ized, the Levant Base abolished, a Delta District Command
with headquarters at Cairo for L. of C. defences established,
and the Western Force* for defence of the Nile formed in two
sections, a Northern and Southern, the boundary between them
being a line drawn from east to west through Deirut. G.H.Q.
remained at Ismailia.

The Anzac Corps was transferred to France and a second
Anzac Corps organized, under Lieut-General Sir A. Godley,
of the 4th and 5th Australian Divisions.

During April 1916 reconnaissances were carried out by
troops from the Suez Section (No. 1) and the Ismailia Section
(No. 2) of the Canal Defences by detachments of the Australian
Light Horse and Bikanir Camel Corps.

No. 3 Section (Kantara) became the base for the defensive
advance into the Sinai Peninsula, the first objective being
the Katia District, a water-bearing zone of about 15 miles
extent. Katia was some 30 miles from Kantara. The railway
line reached to within 7 miles of it by the 21st April 1916,
and was then near enough for a general advance to be made.
A Katia District Command under No. 3 Section of the Canal
Defences had been formed about a fortnight earlier with an

* The command of this Force was taken over from Major-General Peyton
by Major-General C. Dobell and in May 1916 by Sir Bryan Mahon, but
shortly afterwards by Major-General A. G. Dallas.

MEDICAL SERVICES IN EGYPT 367

advanced post at Oghratina, 5 miles east of Katia, held by
a squadron of yeomanry. A mobile column, designated the
Desert Column, was formed under Lieut-General Hon. Sir A.
Lawrence, as the advanced guard of No. 3 Section of the
Canal Defences, and subsequently of what was designated
the Eastern Force under Lieut.-General Sir C. Dobell.
The Eastern Force Command included all sections of the
Canal Defences. It received the designation " Eastern
Force " in October 1916.

On the 23rd April 1916, the positions were attacked by a
large enemy force. The post at Oghratina was overwhelmed
and destroyed. Katia was attacked and fell, and the British
force retired to Dueidar, some 13 miles east of Kantara. The
enemy attacked Dueidar but was repulsed. The British
casualties in this affair were 2 officers and 18 other ranks killed,
and 4 officers and 21 other ranks wounded, in addition to
three and a half Yeomanry Squadrons and other details lost
at Oghratina and Katia.

Beyond bombing and reconnaissance of enemy camps 20
to 30 miles east of Katia, and destruction of a water supply in
rock cisterns 40 miles south-east of Ismailia, there were no
active hostilities until the 4th August 1916. On that date
the first important battle on the Eastern front was fought,
and from then onwards the Desert Column and Eastern Force
steadily advanced along the coast route of the Sinai Peninsula,
and cleared it of the enemy by the occupation of Rafa on
the 9th January 1917. Unsuccessful efforts were made for
the capture of Gaza on 26th March and 17th to 19th April
of that year. The attack on Gaza was to be resumed on the
20th April but, as the losses likely to be involved could not
be justified, further operations were abandoned and a period
of trench warfare ensued which lasted until the end of October
1917, the Eastern Force entrenching itself from Tel-el-Jemmi
on the Wadi Ghuzzee to El Ajlin on the coast west of Gaza,,
with cavalry patrols working to the south and south-east.

The Eastern Force then came under the command of Lieut.-
General Sir P. Chetwode, and the Desert Column under Major-
General Sir H. G. Chauvel.

The Canal Zone was organized into a Southern and Northern
Section, the latter being reorganized as the Palestine L. of C.
from the Suez Canal to Khan Yunus in May 1917.

General Sir E. Allenby succeeded Sir A. Murray in command
of the Egyptian Expeditionary Force on 28th June 1917,.
and from that time onwards to the end of the war the military

36S MEDICAL HISTORY OF THE WAR

situation, so far as Egypt was concerned, was that of a base
for the operations in Palestine. No active operations of any
moment were carried on in Egyptian territory.

For the advance into Palestine the organization of the
Eastern Force and Desert Column was changed into that of
an Army of two Corps, the XXth and XXIst, of three divisions
each, and a Desert Mounted Corps of three mounted divisions.
Palestine was definitely invaded in September 1917 by this
force. Gaza and Beersheba fell ; the army rapidly advanced
and held a line from Jaffa to the Jordan valley from the end
of 1917 to September 1918, when a decisive battle was fought,
leading to the occupation of Damascus and the territory
north of it. During these operations alterations were made
in the composition of the Mounted Corps and the XXth and
XXIst Corps. The 3rd and 7th Indian Divisions, which had
fought in France and subsequently in Mesopotamia, replaced
British divisions in January and May 1918. A fourth mounted
division was added to the Mounted Corps. Hostilities against
the Turks eventually ceased with an armistice on the 30th
October 1918.

Administration of the Medical Services.

The preceding sketch of the military situation in Egypt
during the war and the operations for its defence will serve
to indicate how complicated and difficult the administration
of the medical services became. When the British garrison
was withdrawn and replaced by the 42nd Territorial Division,
Australian, New Zealand and Indian troops in 1914, the
D.D.M.S., Colonel N. Manders, his D.A.D.M.S. for Sanitation,
Major Bagshawe, and the senior medical officers at Cairo
and Alexandria, Lieut. -Colonels Knaggs and Beach, of the
original R.A.M.C. garrison remained.

The 42nd Division had its A.D.M.S., Colonel J. B. Mann,* with
it, and the Indian troops a D.D.M.S., Colonel Robinson, I.M.S.,
while the Director-General of the Australian Army Medical
Corps, Surg. -General Williams, accompanied the Australian
contingent to Egypt. Consequent upon this multiplication
of administrative medical interests, a D.M.S., Surg.-Generai
R. Ford, was appointed to the staff of Sir John Maxwell. He
arrived in Egypt towards the middle of December 1914. He
organized an administrative medical staff for Alexandria,

* Colonel Mann was invalided in June 1915 and was succeeded by-
Colonel T. P. Jones, R.A.M.C.

MEDICAL SERVICES IN EGYPT 369

Cairo, and the Canal Defences, Colonel Manders becoming
A.D.M.S., Cairo, Colonel Beach, A.D.M.S., Alexandria, and
Colonel Robinson D.D.M.S., of the Indian troops and Canal
Defences, with the A.Ds.M.S. of the new Indian divisions
manning the Canal sections under him. The A.Ds.M.S. of the
Australian Division, Colonel Howse, and of the New Zealand
and Australian Division, Colonel Wills, were under the direct
administration of the Director-General Australian Medical
Corps ; but Surg.-General Williams left shortly after his
arrival for London and did not return till February 1915,
and went back to Australia in the following April. He again
passed through Egypt in June 1915, and took his office staff
with him then to London. The D.M.S., Egypt, consequently
appointed an Australian medical officer, Lieut. -Colonel Barrett,
as an A.D.M.S. on his staff, to represent the Australian Medical
Service.

When it was decided to send an Expeditionary Force to the
Dardanelles, a form of dual medical control was evolved in
Egypt. An A.D.M.S., Colonel Sexton, was appointed to
administer the medical services of the docks and camps of
the Dardanelles Expeditionary Force base at Alexandria
and between that city and Aboukir. He was under the
control of the D.M.S. of the Expeditionary Force, who was
independent of the D.M.S. , Egypt, although his duties were
apt to conflict with and overlap those of the A.D.M.S.,
Alexandria.

Owing to the demand for co-ordination of medical adminis-
tration, not only in Egypt and the Dardanelles, but also in
Malta and Gibraltar, and subsequently in Macedonia, the
Army Council appointed a Principal Director of Medical
Services for the Mediterranean generally with headquarters
in Egypt. Surg.-General W. Babtie, then D.M.S., India,
was appointed and arrived in Egypt on 15th June 1915,*
with Lieut.-Colonel T. A. Granger, who held a similar appoint-
ment on his staff in India, as his A.D.M.S. He then
brought Lieut.-Colonel Stammers from Malta to act as his
A.D.M.S. for Sanitation.

Surg.-General Babtie and his staff were not attached to the
staff of any military commander, and had no permanent
office until a month later, when one was established in Alexan-
dria, and towards the end of 1915, in Cairo. The position
of an administrative medical officer attached to no military

* He had already paid a visit of inspection of the Indian Expeditionary-
Force in Egypt, in February and March 1915.

(10134) GG

370 MEDICAL HISTORY OF THE WAR

command was anomalous, and led to a form of triple adminis-
tration in Egypt, that of the P.D.M.S., of the D.M.S., and
of the A.D.M.S., Mediterranean Expeditionary Force base as
representing the D.M.S. of that Force. Surg.-General Babtie's
functions may, however, best be described as those of inspec-
tion and co-ordination of the medical work of the various
Mediterranean Commands and Expeditionary Forces on behalf
of the Director-General of the Army Medical Service at the
War Office. When he was appointed by the Army Council,
the duties assigned to him were to assume command of the
medical services of the Mediterranean Expeditionary Force,
Egypt and Malta, and be responsible for their co-ordination
in these three commands. He was made directly responsible
to the Army Council for the general working of the medical
services and to the Commanders-in-Chief for any advice or
action taken in their commands. But his duties did not
relieve the Ds.M.S. of the Commands of their responsibilities
and administration. He was also to arrange for the reception
of the sick and wounded from the Dardanelles in Egypt and
Malta, and for an equitable distribution of personnel in the
three commands ; to tender advice with regard to sanitation
and to co-operate with the Q.M.G/s branch of the staff and
the Naval Transport Officer for the working of hospital ships.*

For a considerable time the evacuation of sick and wounded
to and from Egypt was in the hands of Surg.-General Sir J.
Porter, formerly Director-General of the Royal Navy Medical
Services, who had been appointed Principal Hospital Transport
Officer in July 1915. His headquarters were at Mudros, but
he was represented at Alexandria by Engineer-Captain Ter
Veen, R.N. With both of these officers Surg.-General Babtie
was in constant touch. This method of directing evacuation,
however, did not prove satisfactory and came to an end at
the beginning of December 1915, when the control of evacuation
of sick and wounded to and from Egypt was taken over by
the P.D.M.S. Surg.-General Babtie was recalled for duty at
the War Office in March 1916, and the appointment of a
P.D.M.S. Mediterranean was then abolished.

On the return of the Dardanelles Expeditionary Force to
Egypt at the end of 1915 and beginning of 1916, the D.M.S.
of the Force administered, independently of the D.M.S.,
Egypt, the area under the command of Sir A. Murray ; but
when the dual command ceased in March 1916 with the forma-
tion of the Egyptian Expeditionary Force, the D.M.S. of that

* See Final Report of the Dardanelles Commission, p. 155.

MEDICAL SERVICES IN EGYPT 371

Force administered the whole of the medical services in Egypt
and its frontiers. Dual medical control thus ceased also,
but a number of subordinate administrative medical appoint-
ments were made then or had been made previously. There
were thus an A.D.M.S. for the Western Frontier Force, an
A.D.M.S. for the Southern Force, and a D.D.M.S. or A.D.M.S,
for each of the three sections of the Canal Defences. An
A.D.M.S. was also appointed for Egyptian hospitals, which
were provided for the sick and wounded of the Egyptian
Labour and Camel Transport Corps and Turkish Prisoners
of War. On the departure of the Indian divisions from the
Canal Defences, Colonel Robinson's appointment as D.D.M.S.
of the Defences lapsed, but he remained in Egypt as D.D.M.S.
for Indian troops and hospitals. On the abolition of the
Levant Base, its A.D.M.S. became a D.D.M.S. for the L. of C.
of the Egyptian Expeditionary Force.

On the formation of the Eastern Force and Desert Column
for the advance in the Sinai Peninsula, a D.D.M.S. was
appointed to each, the D.D.M.S. of the Desert Column being
regarded as subordinate to the D.D.M.S. of the Eastern Force.
The Canal Sections were then administered by D.A.Ds.M.S.
under the D.D.M.S., Eastern Force, and the divisions of the
Force and Desert Column by divisional A.Ds.M.S. The
D.D.M.S., L. of C, was abolished. He became D.D.M.S. of
the Eastern Force, while the D.D.M.S. of the 3rd Section of
the Canal became D.D.M.S. of the Desert Column.

When these changes in organization took place, the Western
Frontier Force and Southern Force were merged into one.
The A.D.M.S. of the latter became the A.D.M.S., Western
Force. This appointment was again merged into that of an
A.D.M.S., Delta and Western Force, in February 1917, and
eventually at the end of the year divided into two administrative
appointments, that of A.D.M.S., Delta, for lower Egypt, and
A.D.M.S., Egypt, for upper Egypt. The only appointment
which remained unaltered throughout was that of A.D.M.S.,
Alexandria.

Finally, when the forces were reorganized by Sir E. Allenby
into corps for the invasion of Palestine, a D.D.M.S. was
appointed to each corps, under the D.M.S. of the Expeditionary
Force ; while the medical services on the Palestine L. of C.
were placed under the administration of an A.D.M.S.

The staffs of the administrative medical officers consisted
of Assistant or Deputy Assistant Directors of Medical Services
for general and sanitary duties. But in addition to these there

372 MEDICAL HISTORY OF THE WAR

were several consultants, specialists and scientific workers
attached to the administrative medical services. During the
Dardanelles period there were at least six consulting surgeons,
who took it in turn to serve in Egypt, Mudros or Gallipoli.
A War Office Advisory Committee on Epidemic Diseases,
known as the " Hunter Committee," under the chairmanship
of Colonel W. Hunter, had its headquarters in Egypt and
visited the various areas of operations in Egypt, the Dardanelles
and Macedonia. A local committee, under Sir David Semple,
the Director of Public Health in Egypt, was appointed by the
D.M.S., Egypt, to supervise the sanitation of the Canal Zone.
Lieut. -Colonel Sir R. Ross was sent by the War Office to
Egypt and Macedonia in the summer and autumn of 1915 in
connexion with anti-malarial measures. Lieut. -Colonel Leiper
was appointed to investigate the causes of bilharziasis, and
Major Austen to advise on fly and mosquito prevention.
Their work is described in the volumes on the Hygiene of the
War.

The Medical Units.

The Field Ambulances. — The only medical units which
arrived with the Indian and Dominion Contingents and the
42nd Division (T.F.) in 1914, were the field ambulances. With
the arrival of Yeomanry, and other mounted units, and with
formations composed of Indian and British troops, the variety
of field ambulances became great and the designations of
many of them were frequently changed. There were R.A.M.C.
field ambulances with British divisions, mounted field ambu-
lances with Yeomanry brigades, Indian field and cavalry field
ambulances and combined field and cavalry field ambu-
lances for those divisions which included Indian units.
Australian and New Zealand divisions and mounted brigades
had their own field ambulances. All these changed their
designations with each change of designation in the formation to
which they belonged or were attached. British became
Indian, Indian British, mounted dismounted, Yeomanry camel
corps field ambulances, and practically every variety of change
took place, as may be indicated by a glance at the accompanying
chart, which shows how some field ambulances went through
various phases of change, with, eventually, the entire loss
of their original identity.

The equipment of field ambulances depended on the character
of the operations. Desert transport replaced the ambulance
wagons and cars in operations in the desert, but ambulance

Chart showing the changes which took place in
the designation of certain field ambulances
during the egyptian and palest ine operations

/9I8

UNIT

J9I6

1917

t/2 S:W<st Border MCd.Bdt.f. A.

Wtlth Border Mtd. Bde. F. k .
DistnCd. (Yco.) Bdc.F. A

N*2o/ F.A.

1/1 Miohlond Mtd.Bde.F.A

1/1 Lowland Mtd.Bde. flT.

N« 229 F A.

l/f Eastern Mtd.Bde. F.K.

1/1 SrEasttrn Mtd. ftd«. F.A

N« 22>0 F. A

1/lScottUh Horse F.A!

Imperial Camel Corps FA.

J/2 S. Midland Mtd.Bdt.F.A

»« Mtd. Bdc F.A

Mhow Cavalry Bdc. FA

6* Mtd. Bde. Comb. F. AT

10* Cavalry Bdc. Comb. F.A

»/4 London Mtd. Bdt."F7AT

B* Mtd. Bde. F.A.

Luck now Cav. Bde. F.A.

8«HLuckno*a MMTBdt. F.A.

N*7j5j Indian Comb. F. A.
1 I * Cav. Bde. Comb. F. AT

*=7

>/l N. Midland Mtd. Bde. F.A

22"* Mtd. Bde. F.A.
Siatkoht Cav. Bde. F.A"

NO- 109 Indian Comb. F. A~
22 nd Mtd. Bde. Comb. FA

12** Cav. Bde. Comb. FTST

1/1 S. Midland Mtd.Bdt.F.A

5* Mtd. Bde. FA.

Awbala Cav. Bde. F.A.
5*> Mtd. Bde- Comb. FA?

7=7

13 * Cav. Bde. Comb. FA-

1/1 Notfr & Derby Mtd.BdtlFA

7* Mtd. Bde. F.A.

Sccunderabad Cav. Bdc. F.A
7* Mtd. Bdc. Comb. F.A

Bdc.

I4th Cav. Bc(T. Comb. F.A.

N°I24 Indian Cav. FA"

Jodhpur Cav. Bde. F.A

IS* Cav. Bde. Comb. F.A.

N°J21 Indian F.A.
N° 121 Indian Comb. FA:

N° IIP Indian FA.
N»I57 Indian F.A

N°I23 Indian F.A

N° 123 Indian Comb. F.A.

—Hi

THE BLACK COLUMNS INDICATE THE PERIODS DURING WHICH THE DESIG-
NATIONS REMAINED UNALTERED; THE ARROWS SHOW THE AMALGAMATIONS
OR CHANGES IN DESIGNATION WHICH SUBSEQUENTLY OCCURRED.

13 28480.5060/ 14-1. 1500. //.23.

H.M.S.O..C'

MEDICAL SERVICES IN EGYPT 373

cars were again given to them when roads were suitable.
As a rule, especially in the operations of the Desert Column,
the field ambulances were formed into mobile and immobile
sections, the latter depending for their movements on any
camel transport that might be required being provided at
the time. The mobile sections were provided with camel cacolets,
sand carts, sand sledges, and bicycle or wheeled stretcher carriers.
These took the place of the normal ambulance car and wagon
transport ; but a modified scale of motor ambulance cars was
allotted to divisions. In this way two of the three sections
of a field ambulance were made mobile, and one immobile.

Ambulance Convoys. — Only one organized motor ambulance
convoy, No. 35, was sent to Egypt in March 1917 ; but motor
ambulance convoys had been improvised for work at Alexandria,
Cairo and Kantara, chiefly of cars provided by the Australian
and New Zealand Governments, but also by ambulance cars
of divisions sent to the Dardanelles, and by cars withdrawn
from the divisions in Macedonia. Thus, there were at one
time 45 cars at Alexandria, 30 at Cairo and 30 at Kantara.

For work with the columns motor ambulance convoys
were improvised of the cars of field ambulances. Camel
convoys were also formed with cacolets and litters as reserve
convoys for clearing dressing stations over desert routes.

Ambulance Flotillas.- — On the Canal ferry boats, motor
launches, barges and steamers were used for the transport
of sick and wounded. Two Nile steamers, the " Niagara," and
" Indiana," were specially fitted as hospitals to carry 50
lying or about 200 sitting. They were employed for bringing
patients from posts on the Canal to the hospitals at Port Said,
Ismailia or Suez.

Casualty Clearing Stations. — In the early stages of the war
Egypt possessed no casualty clearing stations ; but No. 1
Australian CCS. stayed in Egypt during the first three months
of 1915, previous to going to the Dardanelles, and those with
the Dardanelles Force returned with it to Egypt and remained
there for a longer or shorter period until distributed to other
theatres of war in 1916. Nos. 24, 26, 35, 53 and 54 C.C.Ss.
were thus in Egypt in 1916 and were retained throughout
the year. No. 24 went to France in March 1917 and No. 35
to Salonika in May 1918. No. 53 was re-designated No. 65,
and No. 54 became No. 66 CCS. in July 1917. At the same
time four new casualty clearing stations were organized,
Nos. 74, 75, 76 and 77, in Egypt. Nos. 65, 75 and 77 were
disbanded in June 1918, on the formation of new casualty

374 MEDICAL HISTORY OF THE WAR

clearing stations, designated combined clearing hospitals ;
so that at the time of the armistice only Nos. 26, 66, 74 and
76 retained their original designation.

All these casualty clearing stations were employed on the
Palestine Lines of Communication, under the administrative
control of the A.D.M.S. of the L. of C. ; but during the opera-
tions in the Sinai Peninsula they were directly under the
D.D.M.S. of the Eastern Force or Desert Column. They
were units at that time, which retained more or less the
equipment of a casualty clearing station on mobilization
scale, and did not expand into the large immobile units which
were evolved during trench warfare on the Western front,
and later in Palestine.

In 1918, when Indian Divisions replaced British Divisions
in the XXth and XXIst Corps in Palestine, six combined
casualty clearing hospitals for British and Indian sick and
wounded were organized, and numbered 15, 24, 31, 32, 33 and
34. The first three of these came direct from India, and the last
three were formed by the disbanding of Nos. 65, 75 and 77 C.C.Ss.

Ambulance Trains. — Ambulance trains were constructed
in Egypt when the Indian Expeditionary Force arrived in
December 1914. Three ambulance train units, designated
X, Y and Z, were mobilized in Poona and sent to Egypt.
They took over three hospital trains, which had been prepared
in the railway workshops at Cairo in anticipation of their
arrival. These trains were composed of nine coaches, of
which seven were fitted for carrying twenty patients each
in double-tier cots, with the exception of one, which was
partly occupied by one of the medical officers, and as a dis-
pensary and bathroom. There were also coaches for the
commanding officer, personnel, kits, rations and other articles,
and a dining car of the ordinary type.

A fourth and a fifth train were formed later on in 1915,
the former staffed by personnel from one of the Indian hospitals.
All these trains were employed in Egypt west of the Suez
Canal. The Indian ambulance train units were eventually
withdrawn in April 1916, and replaced by R.A.M.C. personnel.
When a railway was constructed into the Sinai Peninsula,
new ambulance trains were prepared or improvised. They
had to be lighter than those employed on the lines west of
the Canal. The first two of these, No. 6 and No. 7, were
formed at the end of 1916, the former of six coaches of the
London and South Western Railway, with fixed cots, and
the latter apparently of converted third-class carriages with

MEDICAL SERVICES IN EGYPT 375

the stretchers carried on slings. An emergency train was
prepared with stretchers on Brechot-Desprez-Ameline frames.
They were used during the first battle of Gaza, and a ninth
train was added after the battle. Up till then Egyptian
Labour Corps and Camel Transport Corps sick and wounded
and Turkish wounded prisoners of war were carried in coaches
attached to these trains, but this proved inconvenient, and
the coaches for them were formed into No. 10 and No. 11
Trains for Egyptian and Turkish sick and wounded.

After the invasion of Palestine, an ambulance train, No. 40,
constructed in England for the Mediterranean Line of Com-
munication, was sent to Egypt, and the trains No. 1 to No. 11
were re-numbered to avoid confusion with the numbered
ambulance trains in France and elsewhere. Nos. 1, 2 and 3
became Nos. 44, 45 and 46 Ambulance Trains. Others were
re-numbered 43, 47, 48, 49, 50, 51, 56, and 57 ; but changes
in numbering occurred more than once, and are not clearly
recorded. No. 49 and No. 57 were the new numbers given
to trains Nos. 10 and 11 for Egyptians and prisoners of war.
The general result, however, is that five trains were employed
west of the Canal, and six or seven east of the Canal, while
only one, No. 40, was of the type used in France and Italy.

As only Nos. 6 and 7 Trains were available east of the Canal
during the operations in the Sinai Peninsula, a number of
improvised truck trains were used as occasion required They
went up with supplies to railhead and were fitted there by a
sanitary section to carry slighter cases of sick and wounded
on the return journey. The trucks had tarpaulin covers,
and were provided with mattresses and pillows for the patients.
Arrangements were made for hot meals being given at stations
along the route. An orderly was placed in each truck, and
this personnel, with the mattresses and pillows, returned to
railhead in the next outward journey of an ambulance train.

None of these trains east of the Canal were permitted to
cross the Canal into Egypt. They ran as far as Kantara on
the east bank, and the sick and wounded were received into
the medical units there, taken across the Canal in ambulance
cars, and entrained on the west bank in the Egyptian trains
for distribution to the hospitals in Egypt.

Hospitals. — The military hospitals in Egypt before the
war have already been described. They were expanded to
their utmost capacity. The 42nd Division brought no medical
units with it other than its three field ambulances. Similarly,
the two Australasian divisions arrived with field ambulances

376 MEDICAL HISTORY OF THE WAR

only ; so that hospital accommodation had to be provided
in the existing hospitals until general and stationary hospitals
and casualty clearing stations in proportion to the number of
troops and formations in Egypt arrived.

The units forming the 10th and 11th Indian Divisions were
accompanied by field ambulances and by two Indian General
Hospitals, No. 5* and No. 8, which arrived in Egypt early in
December 1914. A third Indian General Hospital, organized
by a voluntary committee and known as the Bombay
Presidency General Hospital, arrived a month later. These
hospitals were at first placed at Kantara and Suez, but were
moved later to permanent buildings in the Citadel, Cairo, and in
Alexandria, with a detachment at Suez. No, 5 Indian General
Hospital remained in Egypt till the end of the war, being
eventually concentrated at Suez, with a section at Kantara
during the operations in Palestine. No. 8 and the Bombay
Presidency Hospital returned to India in April 1916, after
the 10th and 11th Indian Divisions were broken up.

Immediately after the Australian divisions arrived in Egypt
the want of Lines of Communication hospitals for their sick
and wounded was realized. A casualty clearing station
(No. 1 Australian), two stationary hospitals (No. 1 and No. 2
Australian) and two general hospitals (No. 1 and No. 2
Australian) were organized and equipped in Australia on the
scale of the corresponding units in War Establishments. They
arrived in Egypt early in January 1915. Until then the sick
of the 1st Australian Division were received into a temporary
hospital in the Mena Palace Hotel, staffed by its field ambulances,
and those of the 2nd Australian and New Zealand Division
into the military hospital, Cairo. The casualty clearing
station (No. 1 Australian) was placed at Port Said, where
it formed a small hospital in anticipation of fighting on the
Canal. It joined the Mediterranean Expeditionary Force in
March 1915, returned to Egypt in January 1916, and went
to France at the end of March 1916.

On arrival in Egypt No. 1 Australian Stationary Hospital
was placed in the camp of the Australian Light Horse at
Maadi, and No. 2 in the camp at Mena. The former
moved to the base camps of the Mediterranean Expeditionary
Force at Alexandria and went to Mudros in advance of
the main body of the Dardanelles force. No. 2 accompanied
the Force to the Dardanelles in April 1915, but returned in

* No. 5 had included in its organization sections of No. 6 Indian General
Hospital.

MEDICAL SERVICES IN EGYPT

377

January 1916 and remained with the Egyptian Expeditionary
Force till the end of the war. No. 1 Australian Stationary
Hospital also returned to Egypt from the Dardanelles and left
in August 1916 for England.

A stationary hospital had also been organized in New
Zealand. It went, however, to Salonika, returned to Egypt
in March 1916, and left for France three months later. The
only other New Zealand hospital unit in Egypt was a general
hospital which became No. 2 Stationary Hospital and was
opened in the Egyptian Army Hospital at Abbassia after
the Dardanelles Expeditionary Force was organized.

No. 1 Australian General Hospital opened in the Heliopolis
Palace Hotel and No. 2 in the Mena Palace Hotel on arrival,
but the latter was transferred to the Gezira Palace Hotel

No. 17 General Hospital, Alexandria.

west of Cairo on the Mena camp breaking up. Both these
units remained in these localities until they were moved to
France with the Anzac Corps in March 1916.

These were the only medical units in Egypt until the
Mediterranean Expeditionary Force was formed, other than
the field ambulances and the Army Base Depot of Medical
Stores in Cairo. The amount of sickness, however, was great,
and the hospitals, especially No. 1 Australian General Hospital,
gradually expanded, taking over one building after another
in Heliopolis, until it became a unit of considerable dimensions,
with sections for infectious and venereal diseases. Eventually
some of the sections developed into separate units and were
taken over by the R.A.M.C.

When it was decided to undertake operations in the
Dardanelles, four general hospitals were sent to Egypt from
the United Kingdom, to act as base hospitals for the force.

(10134)

GG*

378

MEDICAL HISTORY OF THE WAR

Two (Nos. 15 and 17) arrived in March, and the other two
(Nos. 19 and 21) at the beginning of June 1915. They were
all opened in Alexandria, No. 15 in the " Abbassia Schools,"
No. 17 in the Victoria College, No. 19 in the Deaconesses'
Hospital, a German hospital, and No. 21 in Ras-el-Tin
barracks. They were nominally under the administrative
control of the D.M.S. of the Mediterranean Expeditionary
Force, Surg. -General W. G. Birrell, whose representative
in Egypt was Colonel Sexton, the A. D.M.S. of the Base at
Alexandria. The inconvenience of the administrative control
not being in the hands of the D.M.S., Egypt, was, however,

Tented portion of No. 17 General Hospital, Alexandria.

obvious from the very first, and it was subsequently arranged
to place them under the administrative control of the A. D.M.S.,
Alexandria District. With the exception of No. 15, which
was closed in April 1918* all of these general hospitals
remained till the end ot the war in Egypt.

The French " Armee Expeditionnaire d'Orient," under
the command of General D'Amade, was encamped at
Alexandria previous to embarking for the Dardanelles ; and
the sick from it were admitted to the French hospital in
Alexandria and also to the Bombay Presidency General
Hospital, which was close at hand. The latter was, in fact,

* The personnel of this hospital was transferred to Salonika to form
No. 64 General Hospital there.

MEDICAL SERVICES IN EGYPT

379

handed over to the French and the Indian sick transferred
to the Indian General Hospitals.

During April 1915 great activity prevailed in Egypt in
anticipation of a large number of sick and wounded being
received from the Dardanelles. No. 1 Australian General
Hospital was expanded, as already noted, by taking over
the Luna Park Buildings and other buildings at Heliopolis,
and the Hyat Hotel at Helouan, both of which could expand to
between 1,500 and 2,000 beds each, while No. 2 Australian
General Hospital, in moving from Mena Palace to the Gezira
Palace Hotel, increased, its accommodation to about 1,000
beds, retaining the Mena Palace Hotel as an overflow hospital.

Dining hali and ward at Xo. 17 General Hospital, Alexandria.

The Military Hospital in Cairo Citadel was expanded and
improved. A fine modern hospital, the Austrian Hospital,
at Choobra, near Cairo, was taken over for infectious cases.
The Egyptian Government hospitals at Alexandria, Suez and
Port Said were prepared to receive wounded, and the large
native hospital, Kasr-el-Aini in Cairo, was also warned to be
ready. The Greek hospital at Alexandria placed 170 beds at
the disposal of the military authorities, and a convalescent
camp was established at Mustapha The British Red Cross
Society also began to take action in Egypt at this time and to
establish convalescent hospitals, eventually providing some
twelve or thirteen auxiliary hospitals. In this way the

380 MEDICAL HISTORY OF THE WAR

hospital accommodation in Egypt was expanded from approxi-
mately 5,000 beds at the beginning of April 1915 to some
15,000 beds at the time the troops left for the Dardanelles.

There was, however, a great deficiency of nursing sisters,
as Nos. 15 and 17 General Hospitals arrived without a nursing
staff, on the supposition that they would be sent to the Dar-
danelles. The I). M.S., Egypt, consequently obtained, through
the goodwill of various authorities, as many nurses as possible
from civil sources and also the assistance of several ladies
and a large number of nursing sisters from the Australian
and New Zealand hospital units, which had brought with them
ninety- two nurses each, or double the number in a British
general hospital. Eventually a Principal Matron, Miss Oram,
arrived on the 10th May 1915, bringing a few nurses with her.
Shortly afterwards many more were sent from England.
They were distributed to the various hospitals, and relieved
the situation. Reinforcements of nursing sisters and members
of Voluntary Aid Detachments then continued to arrive
monthly, as well as batches of nurses from Australia and
New Zealand, so that at the end of 1915 there was a considerable
surplus of nursing sisters in Egypt. The Khedival Hotel,
Alexandria, and the Semiramis Hotel, Cairo, were taken over
for their accommodation.

Wounded began to arrive from Gallipoli without warning
between the 29th and 30th April. Seven transports bringing
a total of 125 officers and 3,221 men came during these days to
Alexandria. A continuous flow of sick and wounded of the
British Imperial troops, French and Indians then commenced
to reach Egypt, and approximately 17,000 were landed by the
31st May. Hospital accommodation had to be continually
expanded to meet the requirements ; more especially was
this the case with No. 1 Australian General Hospital, which
eventually had some 8,000 beds in Heliopolis, Abbassia and
Helouan. In these expanded Australian hospitals Arab labour
was chiefly used for domestic purposes, and the feeding of
the patients was done by contract with native cooks. This
extreme expansion of No. 1 Australian General Hospital was
due to the fact that although the British general hospitals had
arrived or were arriving, they were not all ready to receive the
first rush of wounded from the Dardanelles. The four British
general hospitals, however, were expanded to 1,200 beds or
more each, and to relieve congestion in them it was decided in
May 1915 to transfer convalescents to Cyprus, where a camp
for about 350 was formed. The difficulties of transport,

MEDICAL SERVICES IN EGYPT 381

however, were great, and the Cyprus convalescent camp was
abandoned towards the end of 1915.

By the end of June 1915, 27,000 sick and wounded, including
2,000 French wounded, were accommodated in Egypt. They
were in course of being cleared to Malta, the United Kingdom,
Australia and India, from Alexandria, Port Said and Suez.
By the end of July, 31,214 British and 3,000 Indian sick and
wounded had come to Egypt.

The Grand Hotel, Helouan, was then taken over and used as a
convalescent hospital of 500 beds under military commandants.

The month of August 1915 threw a special strain on the
hospitals in Egypt. The D.M.S. was always in the dark as
to what was happening on the Gallipoli peninsula, the strength
of the troops there, and the proportion of the sick and wounded
likely to be evacuated to Egypt, but he endeavoured to main-
tain 10,000 vacant beds for casualties by making full use of
convalescent hospitals and camps. Yet during August 1915,
32 transports or hospital ships arrived at Alexandria with about
20,500 sick and wounded officers and other ranks. Other
hospitals were then opened, including a large British Red
Cross Hospital in a building at Gizeh, outside Cairo, and at
Alexandria a Red Cross Convalescent Hospital was opened
in the Sultan's Palace at Montazah, in addition to a number
of small Red Cross hospitals under the auspices of the British
Red Cross Commissioner, Sir Court auld Thomson.

A Canadian hospital (No. 5 Stationary) arrived at this
time in Egypt and opened in the Cavalry Barracks, Abbassia,
with 400 to 500 beds ; and a military hospital was organized
in the Nasrieh School in Cairo for some 600 beds. At the
end of 1918 it was re-designated No. 88 General Hospital.

From this time onwards till the withdrawal from the Dar-
danelles, Egypt was flooded with sick, chiefly dysentery and
diarrhoea patients, just as up till then it had been flooded
with wounded.

It was this fact and the large number of troops which came
to Egypt from the Dardanelles at the end of 1915, suffering
from dysentery, diarrhoea and epidemic jaundice, that led
the D.M.S. to appoint Sir David Semple as President of the
Sanitary Committee* to supervise the Canal area, where a
large labour corps of natives was being organized. This
committee developed into a Standing Committee! for the
inspection of all the military camps in Egypt.

* Colonel Robinson, I.M.S., Major Lelean, R.A.M.C., Captain Austen and
Captain Rae were the other members of the Sanitary Committee.

f Lieut.-Colonel Evan, Sir D. Semple, Lieut.-Colonel Cathcart Garner,
Major Bagshawe and Captain Austen.

382 MEDICAL HISTORY OF THE WAR

Owing to the large number of sick, other hospitals were
opened in November 1915. Princess Fatima's Palace at
Boulac, near Cairo, was lent as a convalescent hospital for
British troops and took some 500 to 600 patients, and some
of the hotels at Luxor were taken for convalescents. They were
grouped under the designation " Convalescent Depot," Luxor,
and accommodated about 100 officers and 2,300 men. This
depot was some 500 miles by rail from Cairo and hospital
trains ran there periodically. A large convalescent depot
was also opened in Abbassia in November 1915.

Great changes took place in the hospital accommodation
in Egypt after the Dardanelles Expeditionary Force had
returned, and after the Anzac Corps and other Corps were
transferred to France. Additions to the general hospitals
then were, No. 31 from England at the end of December 1915,
which opened in Port Said, and No. 27 and No. 3 (Australian)
from Mudros in February 1916. No. 27 opened in Police
Schools, Cairo, and No. 3 (Australian) in the Abbassia
barracks. They replaced No. 1 (Australian) and No. 2
(Australian) General Hospitals which went to France. No. 8
Indian and the Bombay Presidency Hospital, as already
noted, left Egypt in April 1916, after the Indian divisions
were broken up and the two Indian Divisions from France
had been transferred to Mesopotamia. A section of No. 5
Indian General Hospital, which remained, had formed a
hospital for Indians at Suez in January, which was called
the Indian Base Hospital, Suez, at the beginning of April 1916.

When No. 3 (Australian) General Hospital left for France in
September 1916, it was replaced by No. 14 (Australian)
General Hospital, which remained in Egypt till the end of the
war. It was at first at Abbassia, but, as a large Australian
rest camp had at that time been established at Port Said,
it eventually replaced there, early in 1918, No. 31 General
Hospital, which went to Cairo.

During the period between the withdrawal from the Dar-
danelles and the operations in the Sinai peninsula, no more
general hospitals or convalescent depots were opened, but
several stationary hospitals were added to the Egyptian list
of hospitals. No. 18, which, however, left for Salonika at
the end of 1916, and Nos. 24 and 26 arrived respectively in
January, May and June 1916, and No. 36 in February 1917,
all from the United Kingdom. No. 36 was opened on the
sea coast at Mehamdiya in the Romani area, replacing No. 2
(Australian) Stationary Hospital, which had been transferred

MEDICAL SERVICES IN EGYPT 383

there in November 1916. No. 2 (Australian) from the
Dardanelles and No. 1 (New Zealand) Stationary Hospital
from Salonika had returned to Egypt in January and
February 1916, but the latter left for France three months
later. No. 16 British Stationary Hospital of the Indian
Establishment was also in Egypt during the first five
months of 1916.

When General Sir E. Allenby's operations were in course
of preparation many additions were made to the number of
hospitals. In August 1917, No. 69 General Hospital arrived
in Egypt from the United Kingdom, and four others, Nos. 70
71, 78 and 87, were organized in Egypt. Four stationary
hospitals, Nos. 43, 44, 45 and 48, were also formed in Egypt
at the same time, and a fifth, No. 47, came out from England.
No. 45 went to Salonika in May 1918, and No. 43 was disbanded
a month later at the time when Indian troops were replacing
British.

Most of the stationary hospitals eventually went to Gaza,
Mazaid (near El Arish) and Kantara, on the Palestine L. of C,
and two of the general hospitals, Nos. 69 and 78, to Deir-el-
Belah.

In April and May 1918, when the Indian divisions joined
Sir E. Allenby's Force, seven hospitals, Nos. 39, 41, 44, 45, 50,
51 and 54 Indian General Hospitals were sent to Egypt from
India or Mesopotamia. No. 45 absorbed No. 70 General
Hospital, which was then disbanded. Five were placed on
the Palestine L. of C, Nos. 41, 51 and 54 at Kantara, No. 39
at El Arish, and No. 44 at Deir-el-Belah. No. 50 was estab-
lished at Suez.

The hospitals and convalescent depots in Egypt during
the war were thus of an ever varying character. There is
no definite record of the total number of beds and occupied
beds in them, week by week, but the following tables describe
their number and character during the period of the Gallipoli
campaign, and the approximate number of beds equipped
month by month in 1915, when the numbers of sick and
wounded received into Egypt were greatest. The number
of convalescent camps or depots during that year amounted
to nineteen.

The hospitals, which were established in hotels, schools
and in existing hospital buildings, were equipped with the
usual general and stationary hospital equipment, but for the
improvised hospitals the number of bedsteads obtainable in
Egypt was very limited and native palm wood beds, comfortable

384

MEDICAL HISTORY OF THE WAR

Grand Total
of beds in
Egypt.

CNt^OCDOOOCNCDOOTf
00TfC75(MO5C^<-H00C£)r^

t/5* «M* «* CD* Oi" K CD CD 00* rf*

COO^CDO>^CNt^gi_i

Total
Indian
beds.

CNCDUO'-H^HCNiDOCDtN
OOJCNCN'-hCN^CNCN'-'

io r»^ oq <o co co_ cq uc cn cd_

*-* ~ i-~ CM CN* <N* i-< CN* <N* <N*

iriioiDioiDi/sioiococs

COCOCOCOCOCOCO'^*'^ , CO

Indian

Convalescent
beds.

00 00^00500000
COTfCDOOOi^O^OOOO

I 1 1 1 1 1 1 1 1 1

Indian

Hospital

beds.

ioi/5i/5i/iioioir>.-<a>c<»

"*- "*. ^ "*. "*. "^ "* "l ^ °°.

l/5i/5i/5i/5iOi/5l/5l/5COCN

COCOCOCOCOCOCO'^ ,, 4 , CO

Total

British

beds.

0<-<iO^C75CDt^COCr)CN
COiOCDOINUOCTJCDCOCO
t> CO I> i-« 1/5 r>^ ■«* l> lO CN

British

Convalescent

beds.

~ CN* CN CO* CD* CD* l> CD* <-«*

id
o

British

Hospital

beds.

cNco"tt<Tt<uot>rNoooooo

e
o

1st April 1915

1st May

1st June

1st July

1st August

1st September ,,

1st October ,,

1st November ,,

1st December

1st January 1916

MEDICAL SERVICES IN EGYPT 385

and strongly constructed, were available in practically un-
limited number and at a cheap rate. Mattresses, stuffed
with wool, were also prepared by local contract in unlimited
numbers and in a very few days. These proved invaluable
for the rapid expansion of hospitals. A large number of
mattresses, 2,000, was also sent to the docks at Alexandria
for use on transports at the beginning of the operations in
Gallipoli. Blankets, sheets, towels and ward equipment were
obtained from ordnance stores or by local purchase. An
immense amount of help was obtained from voluntary sources
in establishing these hospitals and especially from the
Australian Red Cross Society, which provided a large number of
hospital requirements both for British and Australian hospitals,
and funds with which to purchase additional comforts.

On the whole, few places presented greater facilities than
Cairo and Alexandria for establishing hospitals in suitable
buildings, and it was fortunate that this was so, as otherwise
hospitals would have had to be pitched under canvas, exposed
to the sand and dust of the desert, as was the experience in
Sinai and Palestine.

Egyptian Hospitals. — A large number of Egyptian hospitals
was established for the sick and wounded of the Egyptian
Labour and Camel Transport Corps. They were administered
by an A.D.M.S., Lieut.-Colonel G. W. Heron, R.A.M.C, and
were staffed by Egyptian medical officers, medical students
and hospital orderlies, with a British supervisory staff of 18
medical officers, a quartermaster and 65 other ranks. The
Egyptian staff was 62 medical officers or students and 400 other
ranks. A D.A.D.M.S. was appointed on 1st October 1917
to assist the A.D.M.S.

In May 1917 there were 17 hospitals of this class with a total,
approximately, of 2,500 beds, distributed in various posts
on the Canal, Sinai L. of C, and in Egypt. The largest units
were in Kantara (750), Ismailia (450) and El Arish (500 beds).

There were also sections for 200 prisoners of war in Kantara,
for 200 at Deir-el-Belah, and for 60 at Port Tewfik. At
Kantara and El Arish cholera hospitals for 30 and 60 beds
respectively, and isolation cholera units with 30 beds each
at Rafa, Deir-el-Belah and Sheikh Nuran were maintained.

The hospitals were numbered as Egyptian stationary
hospitals and detention hospitals, and were moved as required
in conformity with the operations in Palestine. Egyptian
hospitals were thus brought up in 1918 to Ludd, Jerusalem,
Jaffa, and elsewhere in Palestine.

386 MEDICAL HISTORY OF THE WAR

In 1918 the Egyptian hospitals were greatly expanded.
Thus in April, No. 6 expanded to 2,000 beds, No. 4 to 1,500,
and all others to 150 beds each. To meet this expansion
16 medical officers and 150 medical orderlies were added to the
staff.

The Egyptian hospital administration was also charged
with the control of a segregation compound for 500 at Kantara,
recruiting depots at Roda Island, Sohag, Assiut and Esna,
disinfecting plants at Kantara East and West, disinfecting
railway vans, and various other disinfecting apparatus.

A convalescent camp for Egyptian Labour and Camel
Transport Corps and sick and wounded was opened in March
1918 by the Public Health Department, under whose auspices
the Egyptian hospitals were established and staffed. This
convalescent camp moved to Ismailia at the end of the month.
Convalescent camps were also established at Kantara for
1,000, and at Ludd, Jerusalem and Jaffa for 500 each.

All these hospitals received Turkish sick and wounded
and Turkish interpreters were attached to the staffs.

The administration of these Egyptian units was reorganized
in August 1918, when all Egyptian hospitals, and the medical
and sanitary arrangements of the Egyptian Labour and
Camel Transport Corps came under the administrative medical
officer of the Corps, or area of the Palestine L. of C, or Egypt,
in which they were established or employed. The A.D.M.S.,
Egyptian Hospitals, was then attached to the staff of the
D.M.S. at G.H.Q., and his D.A.D.M.S. to the staff of the
Palestine L. of C. Quarantine arrangements, however, re-
mained under the control of the A.D.M.S., Egyptian Hospitals.

Another class of hospital, which did much useful work in
Egypt, were the Government hospitals of the Public Health
Department. Over 5,000 sick and wounded of the British
and Dominion forces were received into them during the period
of the Dardanelles Campaign and the Turkish attacks on the
Canal. Two tented hospitals, one at Ismailia and the other
at Suez, were lent to the military authorities as clearing
hospitals for wounded enemy during these attacks, the equip-
ment being drawn from travelling ophthalmic hospitals,
while five permanent ophthalmic hospitals in towns in Lower
Egypt* were utilized for Imperial, Australian and French

* Tanta, Mansura, Zagazig, Shebin-el-Kom and Damanhour. The Public
Health Department hospitals of Upper Egypt at Beni Suef, Fayum, Minia,
Assiut, Kena and Assouan were also placed at the disposal of the Army and
were freely used for the reception of the sick from the Western Force.

MEDICAL SERVICES IN EGYPT 387

sick and wounded. The clearing hospitals had only received
116 enemy wounded at Ismailia and 8 at Suez, when they
were suddenly removed to Port Said on 1st May 1915 for
the reception of British wounded from Gallipoli. The Public
Health Department also established a hospital for 550 beds
under canvas at Alexandria from May to October 1915, with
a section at Zagazig for Senegalese troops. One hundred
and fifty beds under canvas were also established at Port
Said when the clearing hospitals moved from Ismailia and
Suez. In November these tented hospitals at Alexandria
(Glymenopoulo), Zagazig and Port Said were combined and
moved to Gizeh near Cairo under canvas. All these hospitals
were equipped and manned from various hospitals of the
Public Health Department. The treatment of the sick and
wounded in them was carried out by the Egyptian medical
officers and gave the greatest satisfaction both as regards
comfort of the patients and results. Approximately over
100 qualified medical officers and some 40 nursing sisters
of the Public Health Department, Cairo, gave their services
to the military authorities during the war in Egypt.

The administration of the hospitals remained in the hands
of one of the officers of the Public Health Department
He commanded the hospital at Glymenopoulo and afterwards
at Gizeh.

The Egyptian Government hospital for native patients
at Kasr-el-Aini, Cairo, under the charge of Dr. F. C. Madden,
also received sick and wounded. From the 4th February to
15th April 1915, 166 enemy wounded and 40 enemy sick
were sent to it. During May and June it received military
patients, when it reverted to its civil functions ; but was
opened again for military patients in the middle of July. It
received sick and wounded continuously to the end of the
year, the total number being 1,998 wounded and 2,862 sick
British and Australians from the Dardanelles.

Reception Stations. — The organization of a reception station
was peculiar to Egypt. The first reception station was formed
at Mustapha in August 1915, and continued there till August
1917, when it moved to Kantara with the various base depots
of the Egyptian Expeditionary Force, whose place at Mustapha
was taken by a large " Details Camp " and Command Depot

388 MEDICAL HISTORY OF THE WAR

for malarial and light convalescent cases. After the removal
of the reception station to Kantara its duties were as
follows : —

(1) To take all sick parades of the various depots there.

(2) To examine all drafts arriving from the United Kingdom

and men discharged from hospitals, in order to ensure
their cleanliness and freedom from infective diseases ;
to eliminate all obvious unfits for front line duty,
particularly amongst drafts from the United King-
dom ; to examine and register arrivals from hospitals
and classify them for " temporary base " until they
were passed by a medical board as fit for front line
service or otherwise.

(3) To examine all outgoing drafts for lice or venereal

disease and weed out unfits. The chief causes of
unfitness were boils and septic sores.

(4) To carry out all inoculations for drafts proceeding to

the front and also inoculate the personnel of sta-
tionary units near by.

(5) To prepare all cases for the medical boards. The

president of these boards was a visiting medical
officer and the members were provided by the
reception station.

The reception station began duty with a staff of 7 medical
officers and 12 other ranks R.A.M.C. In the beginning there
was no proper camp for the R.A.M.C. personnel and the work
of the unit was carried on in two marquees at the entrance
of No. 24 Stationary Hospital and in one European privates'
Indian pattern tent (E.P.I. P.) at No. 1 Infantry Base
Depot. Officers and men were living at various camps in
the vicinity. In September a definite camping area was
allotted to the unit and in October the station was opened
in a self-contained camp. The staff consisted of 6 medical
officers, 1 dispenser, 11 other ranks R.A.M.C. and 27 "B"
men* attached. The accommodation was in six marquees,
one as a Board tent, two together, with an E.P.I. P. tent
as dressing rooms, and two with 26 beds as " observation
wards." Later an infectious compound was added and a
motor ambulance car was attached to the unit.
A dental depot was also attached to it.

* " B " men were men fit for duty at the base only.

MEDICAL SERVICES IN EGYPT 389

Laboratories. — Mobile laboratories from the United Kingdom
were not sent to Egypt until April 1918 ; but the Public
Health Department of Egypt placed a railway car, fitted as a
bacteriological laboratory, at the disposal of the military
authorities in April 1915 for use in the Canal Defence Zone.
In February 1917 it was re-designated No. 5 Military La-
boratory, at a time when a series of six military laboratories
was organized for work with the Egyptian Expeditionary
Force. These laboratories were distributed along the L. of C.
from Kantara to railhead, attached usually to a casualty
clearing station or stationary hospital.

A pamphlet was issued to all medical officers containing
instructions for a routine method of treatment and diagnosis,
and, when full use of the stations for the latter purpose was
made, good results were obtained. They were intended to
assist medical officers in correctly differentiating malarial
fevers from other febrile conditions, which might resemble
malaria and which might consequently lead to a false diagnosis
and delay in suitable treatment.

A central base laboratory, organized by Sir David Semple
in the Hygiene Laboratory of the Public Health Depart-
ment, was transferred to Kantara. and attached to No. 24
Stationary Hospital. It was designated the Military Bac-
teriological Laboratory and supplied all the military field
laboratories with special bacteriological equipment and trained
personnel.

In addition there was an Anzac Field Laboratory which
was attached to the Desert Mounted Corps.

Malaria Diagnosis Stations. — In order that severe cases of
malaria might be early recognized and treated suitably a
scheme was prepared by Captain P. H. Bahr, R.A.M.C., and
submitted in February 1918 to the A.D.M.S., Palestine L. of C.
The scheme suggested the formation of separate units, two
for each corps, with a staff of specially trained medical officers
and orderlies, and equipped with two microscopes and other
necessary medical stores. The D.M.S. sanctioned the forma-
tion of the units and they were designated " Malaria Diagnosis
Stations.'' On the 23rd March 1918, seven medical officers
and sixteen orderlies were posted to No. 3 Military Laboratory
for a month's course of instruction. At the end of April two
units were detailed to each corps. Each unit was equipped
with two bell tents, one E.P.I. P. tent, tables, lamps, two
microscopes with slides, stains and other equipment. One
general service wagon carried the unit.

10134 hh

390 MEDICAL HISTORY OF THE WAR

Medical Stores. — The Army Medical Store in Cairo, which
existed before the war, continued its work throughout. No. 4
and No. 5 Base Depots were sent out from England in March
1915, and established at Alexandria. The former became a
large base depot, the Levant Base Depot of Medical Stores,
at the end of the year. No. 4 Advanced Depot came with
and was absorbed by it, till re-mobilized for Palestine in
August 1917. Until the end of 1915 there were no other
advanced depots, with the exception of one Indian Depot
(No. 5)* Nos. 5, 6, 7 and 8 Advanced Depots then came to
Egypt, No. 8 being shortly afterwards absorbed in the Levant
Base Depot. Eventually it became a base depot (No. 8) at
Kantara, and another advanced ,depot, No. 8, took its place
on the Palestine L. of C.

The Levant depot supplied medical and surgical stores, and
equipment for the Dardanelles and Salonika Expeditionary
Forces. It was replenished from the United Kingdom. The
army medical store at Cairo supplied the medical units in
Egypt and the advanced depots during the operations. The
advanced depots were placed at Suez, Kantara and at railhead
during the operations of the Eastern Force and Desert Column
in the Sinai Peninsula. During the operations in Palestine
they were placed at various points on the L. of C, the most
advanced being No. 6, which opened at Ludd in February 1918.
The others were at El Arish, Rafa, Deir-el-Belah and Gaza,
but were moved from time to time in conformity with the
military operations.

In the Alexandria district a central splint factory was
established at No. 21 General Hospital at Ras-el-Tin. It
originated in the great demand for splints of all kinds after
the first landing in Gallipoli, and was commenced by Major
Hey Groves on 25th May 1915. About 50,000 splints of all
kinds were issued from this factory and distributed to Egypt,
Macedonia, Mesopotamia, East Africa and some of the hospital
ships. A staff of native workmen was employed in manufac-
turing the splints. Major Hey Groves was succeeded in charge
of the factory by Colonel Edington who, in his turn, was
succedeed in July 1917 by Major G. R. Livingstone. During
the early part of 1917 there was some difficulty with the native
labourers employed. Up to that time they had been obtained
through a contractor, but when Colonel Edington took over
charge he obtained authority to engage men direct, and this

* No. 5 Indian Depot arrived in January 1915, and opened at Ismailia.
It left for India a year later.

MEDICAL SERVICES IN EGYPT 391

new method of employing labour proved to be very beneficial
in every way, as no labour troubles subsequently occurred,
and the men entered whole-heartedly into their work, and
never failed during strenuous periods. The same difficulty
was experienced in Egypt as in France with regard to the
standardization of splints, owing to the demands of individual
officers to have splints prepared according to their original
designs or just a little different from standard patterns. The
officer in charge of the factory prepared a useful illustrated
catalogue and vocabulary of splints in consequence for the
information of medical officers, and this was of great use in
enabling them to obtain splints of a standard pattern to suit
their requirements.

The medical services in Egypt owed much to the sympathy
and help of the High Commissioner, Sir Henry MacMahon,
Lady MacMahon and many ladies who worked voluntarily
in the hospitals, especially during the periods when Egypt was
flooded with sick and wounded from the Dardanelles. The
Egyptian Civil Medical Service and the Public Health Depart-
ment were invaluable in many directions, not only in receiving
British sick and wounded into their hospitals, but in establishing
and administering, as related above, a series of hospitals for the
Egyptian Labour Corps, Camel Transport Corps and prisoners
of war, and in organizing and carrying out extensive sanitary
work in the camps. Some thirteen convalescent hospitals
and three convalescent homes were opened by these voluntary
workers during 1915. The Sirdar also sent, for temporary
duty under the Director of Medical Services, some twenty
officers of the Medical Corps of the Egyptian Army, some of
whom were employed not only in Egypt, but also in Gallipoli.

Sanitation.

The sanitation of camps in Egypt and in the areas over which
operations were conducted caused much anxiety and required
constant supervision and arduous labour. Waste products
in the earliest stages were removed by contractors, but there
was little or no advance in maintaining a high standard of
sanitation in these camps until incineration was introduced
and became the recognized method of disposal of all forms
of waste products.

Much difficulty occurred at first in the disposal of litter,
offal, excreta and refuse. All conservancy work of the camps
along the Canal banks was being carried out by contract, the
chief camps being Kantara, Ismailia, Moascar near Ismailia,

392 MEDICAL HISTORY OF THE WAR

Serapeum, Zagazig and Suez. Later, incineration methods J
were employed. Vermin were a constant source of trouble.
Disinfestation was effected by the fixed sterilizers of the
Public Health Department at Port Said and Suez, and
by the portable Thresh disinfectors. Eventually, railway
van disinfectors were brought into use and proved extremely
useful and efficient. These van disinfectors were introduced
into Egypt by Colonel W. Hunter in February 1916, as a
result of his experience of their use in dealing with the
epidemic of typhus fever in Serbia in 1915. Several were
subsequently constructed and sent up the Palestine L. of C.
for the use of divisions and corps in the front. They proved
invaluable, and Colonel Hunter records that in the first three
months of their work two double van disinfectors carried out
the disinfestation of 170,000 kits, 170,000 overcoats, 340,000
blankets and great masses of ordnance clothing. They were
the most prominent and effective measure of preventive work
and by their means 60,000 men of the troops and native labour
corps could have their clothing disinfected monthly. During
twelve months, May 1916 to April 1917, amongst an average
strength of 40,000 labour corps men, 495,000 disinfections
were carried out. The Serbian barrel disinfector, originally
designed by Lieut. -Colonel Stammers for use in Serbia in 1915,
was also largely used in Egypt. A galvanized iron bin dis-
infector of the same design was subsequently introduced and
became the recognized means of disinfection by the Public
Health Department in Egypt and Palestine.

There was never any difficulty with regard to water supplies,
for which there were filtration systems from the beginning at
Suez, Ismailia, Port Said and Zagazig. For the most part
water was conveyed in pipes, but to the more remote stations
in water barges. The installation of a chlorinated and piped
water supply from the Sweet Water Canal to the posts in Sinai
was a later development, and is fully described in the volumes
on the Hygiene of the War.

The sanitation of the camps in the Canal Zone was a source
of trouble at all times, and required much supervision by the
administrative and sanitary officers, and eventually by the
Canal Zone Sanitary Committee. Divisions, units, transports,
horses and camels, coming and going to and from the
various camps, added greatly to the difficulty of maintaining
a high standard of sanitation. At first sanitary sections had
to be improvised, until definite sanitary sections, such as those
sent to France, were mobilized for Egypt at a later stage.

MEDICAL SERVICES IN EGYPT 393

The improvised sections were on the Indian model and con-
sisted mainly of sweepers, sent from India. The officers of
the Indian Medical Service to whom most of the sanitary
work on the Canal area was entrusted, worked incessantly
and successfully during 1915 to maintain a high standard of
sanitation. The introduction of immediate incineration me-
thods made a vast difference in the disposal of refuse of all
kinds, and the health of the troops rapidly improved. When
definitely organized sanitary sections arrived in Egypt men
of the Egyptian Labour Corps were attached to them. They
were specially employed in carrying out incineration processes
and proved excellent workers.

An exceptionally interesting Medical Exhibition was opened
at the Nazrieh Hospital in Cairo in March 1919, in which
were shown a very complete collection of photographs,
dealing with every medical aspect of the campaign, specimens
and models of all the means of transport employed, models of
all the sanitary appliances, and an unique collection of
pathological diagrams and specimens dealing with the special
diseases. It was open for four or five days, and special
leave was given to officers and other ranks to visit it.

CHAPTER XX.

THE MEDICAL SERVICES DURING THE OPERATIONS AGAINST
THE FOLLOWERS OF THE SENUSSI AND SULTAN OF DARFUR.

THE concentration of the Western Frontier Force at Mersa
Matruh for operations against the followers of the Senussi
was complete on the 7th December 1915. The force consisted
of a composite mounted brigade and a composite infantry
brigade. The former was composed of three Yeomanry regiments
of the 2nd Mounted Division, a composite regiment of
Australian Light Horse, the Notts. Yeomanry R.H.A., and
ammunition column with auxiliary services ; and the latter
of three T.F. infantry battalions, the 15th Sikhs, the 1st
Australian divisional train and a detachment of engineers from
the Military Works Department of Egypt, with auxiliary
services.

Patrols of infantry, the Bikanir Camel Corps, and an
armoured train guarded the railway line from Alexandria to
Dabaa, some 70 miles east of Mersa Matruh, and also the
Moghara Oasis, some 100 miles due west of Cairo. Troops
were also sent to various posts west of the Nile, to watch the
approaches to it from the western oases further south. These
troops formed what was called the Southern Force, as distinct
from the Western Frontier Force under Major-General Wallace.

On the 11th and 13th December columns went out from
Mersa Matruh and encountered the enerrty, retiring afterwards
to Matruh. The casualties on both days amounted to 1 officer
and 22 other ranks killed and 8 officers and 66 other ranks
wounded.

The force at Matruh was reinforced during December and
formed into a right and left column. The former, composed
of cavalry and infantry, was to advance against Gebel Medwa,
8 miles south-west of Matruh, where 5,000 Senussi were
concentrated, and the latter, composed of Yeomanry and
Australian mounted troops, was to make a wide detour and
cut off the enemy's retreat to the west. A successful action
was fought on the 25th December, the casualties being 14
other ranks killed and 3 officers and 47 other ranks wounded.
The troops then returned to Matruh.

During the earlier part of January 1916 the operations of
the Western Frontier Force ceased on account of torrential

OPERATIONS AGAINST THE SENUSSI 395

rains, but after the weather cleared up, a column of 5 squadrons
of Yeomanry, 1 of Australian Light Horse, 2 battalions of
British infantry, 1 of the New Zealand Rifle Brigade, and 1 of
the South African Regiment, with artillery, armoured cars
of the R.N., a British and an Indian Field Ambulance and
other details, moved out from Matruh on the 22nd January
and bivouacked for the night at Bir Shola, about 19 miles
further west. The enemy was then concentrated at a point
25 miles south-west of Matruh. On the following day the
column advanced and a fierce action was fought 7 miles out
from Bir Shola, resulting in the capture and burning of the
enemy's camp. The casualties in the column were 31 killed
and 291 wounded. They were brought back to Bir Shola
with great difficulty owing to the deep mud of the route along
which they had to be carried. On the 25th January the
force returned to Matruh.

The column was then re-organized and its command taken
over by Major-General W. E. Peyton on 9th February 1916.
The Composite Yeomanry Brigade became the 2nd Mounted
Brigade. A composite brigade of T.F. battalions under
Lord Lucan was formed. The Sikh and New Zealand bat-
talions were replaced by a South African brigade, and two
sections of the Hong-Kong and Singapore Mountain Battery
joined the force. Camel transport was organized with about
2,000 camels.

Decisive operations were then undertaken by the Matruh
Force. The enemy was located at Agagia, some 14 miles
south-east of Barrani, near Solium. A column moved out
on the 20th February. On the 24th February it camped at
Wadi Maktil, where it was attacked on the following day, but
with a loss to the column of only one man killed and one
wounded. The enemy was then attacked at Agagia and a
battle, resulting in his complete defeat, was fought on the 26th
February. The column then marched to Barrani without
opposition. The whole of General Peyton's force assembled
there from Matruh on the 8th March, and advanced by the
coast route to Solium, which was re-occupied on the 14th of
the month. Information was then received that the crews
of the torpedoed ships were at a place some 75 miles west of
Solium. Armoured cars accompanied by motor ambulance
cars went out and rescued them without loss.

On the 23rd November 1915 Lieut.-Colonel E. P. Sewell,
R.A.M.C, was appointed A.D.M.S. of the Western Frontier
Force. His D.A.D.M.S. (for Sanitation) had already proceeded

396 MEDICAL HISTORY OF THE WAR

on reconnaissance of camp sites and water supply at Mersa
Matruh together with the 15th Sikhs and a section of No. 137
Indian Field Ambulance. The other medical units appointed
to accompany the force were the Notts, and Derby Mounted
Brigade Field Ambulance, and the 1/lst South Midland
Mounted Brigade Field Ambulance. The former was attached
to the Infantry Column and the latter to the Cavalry Column.
As the operations were to be conducted against tribes not
likely to respect the medical services, all R.A.M.C. personnel
were armed. The coastguard ship " Raschid " was taken
over and equipped as a hospital ship at Alexandria. Trawlers
had been considered for the purpose but were unsuitable.
Arrangements were also made for sick to be brought back on
the trains running between Alexandria and Dabaa, a N.C.O.,
R.A.M.C, being permanently placed on each train to arrange
for their reception and take charge of them during evacuation
to Alexandria. After organizing the chlorination of wells
along the land route to Matruh, Colonel Sewell left Alexandria
for the latter place by rail and car on the 10th December. The
road from Dabaa to Matruh was bad with deep sand in many
places, and the transport moved slowly and with difficulty.

During the fighting 14 miles west of Matruh on the 11th
December the wounded were received into the Notts, and
Derby Mounted Brigade Field Ambulance, a section of which
was then at Matruh, having proceeded there by sea on 27th
November. The wounded were embarked the next day on
the coastguard cruiser " Abdul Monayon." The total number
of wounded received at Matruh was 18, including 3 officers.
The field ambulance had been opened with 50 beds in a large
shop conveniently near the road and landing stage.

The South Midland Mounted Field Ambulance at this time
was in scattered parties along the road, but part of the
personnel, five light ambulance wagons and medical stores were
at Matruh. The section of No. 137 Indian Field Ambulance
occupied an Egyptian hospital building of fourteen beds.

The field arrangements that had been made for the opera-
tions of the 11th November were for the bearer divisions
of the Notts, and Derby Field Ambulance and the Indian
Field Ambulance sections to proceed with the force with
three ambulance wagons, for a trawler to stand in close to the
shore, and for motor-cars to work along the road to pick up
wounded.

During the attack of 13th December near Ras Um Rakhum
on the British force which remained there after the fighting

OPERATIONS AGAINST THE SENUSSI 397

two days previously, two trawlers were sent out with a medical
officer, five orderlies, and medical and surgical supplies on
each. The trawlers returned on the morning of 14th December
with 48 wounded, including 5 officers. The " Raschid "
hospital ship arrived just as the wounded were about to be
transferred to the field ambulances on shore, and the wounded
and some sick were embarked direct on it for Alexandria,
Six motor ambulance cars arrived the same day in response
to a wire from the A.D.M.S. to the D.M.S., Egypt. They
were employed with cavalry reconnaissance parties.

In the operations of the 25th December, when a column
went out against the enemy at Wadi Merghib, eight miles
from Matruh, a section of No. 137 Indian Field Ambulance with
four sand carts, and the Notts, and Derby Field Ambulance
bearer division with five light ambulance wagons accompanied
the main body, and the South Midland Field Ambulance
bearer division with five light ambulance wagons the Mounted
Column. The ambulance wagons with the main body could
not move off the Khedival road, on account of the exceedingly
rough character of the ground, but they were sent forward to
a point as near the action as possible, wounded being brought
to them on stretchers or by the sand carts of the Indian field
ambulance. The sand carts proved invaluable and picked up
the majority of the wounded. The Indian field ambulance had
opened a small dressing station under Major Seely, I.M.S.,
behind a ridge on which the guns were placed, and a large
number of the wounded passed through his hands. Colonel
Sewell, who was with the main body, ordered the motor ambu-
lance cars to come up to the point on the road, which had been
reached by the ambulance wagons, and to which the wounded
were being brought. As each car was loaded it went off to
Matruh, and in this way 50 wounded were brought to Matruh by
the afternoon. The ambulance wagons were practically not used.

Several wounded had still to be collected after the force
had retired to bivouacs for the night, but eventually all were
brought in.

The ambulance wagons with the Mounted Column kept in
close touch with the troops, but the A.D.M.S. sent out three
Ford cars of the R.N. Armoured Car detachment along the
road towards midday, and brought the wounded back, of
whom there were only four.

The total number of wounded brought to Matruh was fifty-
two. All except the very slight and very seriously injured
were embarked on the hospital ship the next day.

398 MEDICAL HISTORY OF THE WAR

Colonel Sir Victor Horsley arrived as Consulting Surgeon
on the 29th December and left on the 31st December,
having been summoned to see a seriously wounded case.

The chief want felt by the medical services during this
battle was the need of pack transport, and consequently on
the 27th December six pairs of camel cacolets were issued
and fitted on camels.

On the 28th December the column, which went out to
Jeraula, bivouacked there for the night and the following
morning advanced against the enemy position, twelve miles
further south. It was accompanied by the 1/lst South Midland
Mounted Field Ambulance, less a tent sub-division, 10 light
ambulance wagons and 6 camels with cacolets, and by the bearer
sub-division of the section of No. 137 Indian Field Ambulance
and 4 sand carts. Lieut. -Colonel T. H. Forrest, R.A.M.C.
was appointed to act as S.M.O. of the column. His orders
were to bring the casualties to Jeraula, where they would be
taken over by the motor ambulance cars and brought to
Matruh. The column returned to Matruh on the 30th
December without having seen any of the enemy. The long
march over rough ground, however, caused a number of men
to fall out with blistered feet, and 143 had to be carried back
in the ambulance transport. The motor ambulance cars,
which were sent from Egypt, proved useless for work on the
rough roads. The springs became flattened, the frames bent
and the bodies loose. Consequently, application was made
to the D.M.S. for Ford cars with light ambulance bodies to
replace the heavier cars. Fourteen more pairs of camel
cacolets arrived on the 2nd January 1916, so that the A. D.M.S.
had then at his disposal 20 pairs of camel cacolets for 8 lying
and 32 sitting patients.

When the column moved out again on the 12th January
1916 after a period of heavy rains it was accompanied by the
1/lst South Midland Mounted Field Ambulance (less a tent
sub-division) with 5 camels and cacolets, and 3 stretcher
squads of No. 137 Indian Field Ambulance and 4 sand carts,
under Lieut.-Colonel Forrest as S.M.O. An operating centre
was established in a house at Matruh. The column returned
without casualties on the 16th January, but sixty-four footsore
and unfit men had to be carried.

On the 17th January the 2nd East Anglian Field Ambulance
and No. 54 Casualty Clearing Station were ordered to join
the Western Force.

OPERATIONS AGAINST THE SENUSSI 399

On the 22nd January the column moved to Bir Shola, 19
miles westwards along the Khedival road. The medical
units with it were the 1/lst South Midland Mounted Field
Ambulance (less a tent sub-division) with 10 light ambulance
wagons, and " A " Section of No. 137 Indian Field Ambulance
with its 4 sand carts. The 6 heavy ambulance cars and 6
Ford cars were sent to join it on the following day. During
the battle, which ensued on the 23rd January, it was im-
possible to form a dressing station under cover as the ground
was quite level and no shelter could be found. The dressing
station had consequently to work under rifle fire. Only one
of the heavy ambulance cars could come up, the remainder
had stuck in the mud near Bir Shola. The wounded were
then sent back in the Ford cars and transferred to the ambul-
ance cars at Bir Shola at first, but on the second journey back
the Ford cars went on to Matruh without transferring wounded
to ambulance cars. As the fighting line advanced the dressing
station was now further back out of the fire zone. The
wounded were brought to it by the light ambulance wagons
and sand carts, which went as close to the firing line as possible
and picked up the casualties collected by the stretcher bearers.
When fighting ceased at 5.30 p.m. all the wounded had been
collected, but a difficult problem had then to be faced. The
motor ambulance cars and wagons, which had been relied on
to evacuate the wounded, failed to come up, owing to the
state of the roads, and only the 10 light ambulance wagons
and the 4 sand carts were available for carrying about 250
wounded. The G.O.C. then decided to bivouac on the spot.
The wounded were made as comfortable as possible for the
night under such shelter as could be provided. It rained
heavily, and early in the morning evacuation of the wounded
commenced. There were 70 lying down cases and all had
to be carried by hand. Those able to ride, some 100, were
carried on cavalry horses, and the remainder were loaded on
to the ambulance wagons, limber wagons, gun limbers and
ammunition carts. The progress was very slow owing to the
heavy mud, the pace being only about one mile an hour. After
five hours the train of supply wagons was met. The sitting
cases were transferred to them, and the stretcher cases to the
ambulance wagons, and in this manner the first bivouac was
reached. On the 25th January the march was continued.
Ford cars came up and brought the wounded to the point on
the road where the motor ambulance cars were assembled.
By 5 p.m. all had been brought in to Matruh, where the hospital

400 MEDICAL HISTORY OF THE WAR

ship was waiting. The total number of wounded in this
action was 261, of whom 10 were British officers, 3 Indian
officers, 150 were British other ranks and 99 Indian other
ranks. Ninety-seven of the wounded were evacuated on the
26th January by the hospital ship, and 23 on a transport,
the " Messir." The hospital ship returned and evacuated
103 sick and wounded on the 28th January.

Colonel Sewell went back to Alexandria on the hospital ship
to discuss future medical requirements with the D.M.S. and
arranged for a supply of 20 sand carts, 50 pairs cacolets, and
a stationary hospital to be sent to Matruh. No. 16 Stationary
Hospital arrived according to this arrangement on the 31st
January. It opened for work on the 11th February 1916,
on which day Major-General Peyton assumed command of
the Western Frontier Force at Matruh. On the 13th February
a small force proceeded along the coast to establish an advanced
base at Unjeila, 40 miles west of Matruh. A tent sub-division
of the Notts, and Derby Field Ambulance accompanied it. On
the 20th February the column left Matruh to advance to
Barrani, 40 miles west of Unjeila. Both the South Midland
and Notts, and Derby Field Ambulances went with it, the
former to accompany the column beyond Unjeila and form
a dressing station in the event of any battle taking place,
and the latter to establish a casualty clearing station at
Unjeila. All the transport of the Notts, and Derby Field
Ambulance, 64 pairs of camel cacolets for 40 lying and 88
sitting patients, and 20 sand carts, were to accompany the
South Midland Field Ambulance. The six motor ambulance
cars were to work between Unjeila and the battle area, along
the Khedival motor road to Solium.

During the ensuing action of Agagia on the 26th February
a dressing station was established behind a small hill. The
motor ambulance cars were brought up to it, and the sand
carts worked between it and the battle front, over an area
about a mile in depth. The fighting ended at 1.30 p.m. with
the flight of the enemy, and at 4 p.m. the ambulance cars
left with 34 wounded for Unjeila, a distance of 50 miles, of
which 47 were by road and 3 across country. In the cavalry
charge 33 of the British who fell were instantly killed by the
enemy, but 24 wounded were collected by the regimental
medical officers and brought to the field ambulance the
following day, when 70 wounded were taken on to Unjeila
in two journeys of the ambulance cars. More sick and wounded
were placed in the cars next day and sent back to Matruh.

OPERATIONS AGAINST THE SENUSSI 401

The South Midland Field Ambulance was then moved up
to Barrani.

The hospital ship " Raschid " was ordered to Unjeila and
arrived early on the 27th February. An attempt was made
to embark wounded on it, but owing to the heavy sea only
five could be got on board. The following day the ship came
closer in shore and eighty-six patients were taken on board
before embarkation had to be abandoned on account of the
rough sea. The embarkation was effected with great difficulty
and risk, the ship's crew making twenty journeys to the shore
and back in the boats. The patients that could not be em-
barked were taken to No. 16 Stationary Hospital, Matruh,
in the motor ambulance cars.

Barrani now became the advanced base for further opera-
tions and the Notts, and Derby Field Ambulance was moved
to it from Unjeila on the 6th March. A detachment of No. 16
Stationary Hospital was ordered up to Barrani and opened
a 100-bedded hospital there on the 11th March. It arrived
in the hospital ship on the 7th March. Arrangements had
been made for the operations which commenced on the 9th
March. The infantry brigade moved from Barrani that
day accompanied by the Notts, and Derby Field Ambulance,
with 18 sand carts, 11 camels with litter cacolets, and 50 with
cacolets for sitting cases. On the 11th March the Mounted
Brigade moved off accompanied by the South Midland Field
Ambulance with 12 light ambulance wagons and 50 pairs of
cacolets on camels.

The columns reached Solium on the 14th March 1916,
without opposition. On the 16th March the motor ambulance
cars were brought up with great difficulty to the plateau above
Solium, and took part in the rescue of the British prisoners
by the armoured cars on the following day. Ninety-one
prisoners were brought back and transferred at the top of the
pass to cacolets on camels. They left for Alexandria on the
" Raschid " on the 19th March.

A detachment of No. 16 Stationary Hospital was brought
up to Solium on the 17th March. On the 29th March the
Force, having accomplished its object, was dissolved.

The Medical Services with the Egyptian Southern Force.

The Southern Force Command was formed under Major-
General W. E. Peyton on 20th January 1916, with headquarters
in the Kasr-el-Nil barracks, Cairo. The force consisted of
the 53rd Division and attached troops ; 1st Australian Light

402 MEDICAL HISTORY OF THE WAR

Horse Brigade, North Midland Mounted Brigade, Dismounted
Brigade (Highland with the Scottish Horse), and a detachment
of the Bikanir Camel Corps. They were distributed to various
posts in the Nile Valley — at Wadi Natrun, Wardan, Fayum,
Minia and Mena. The South Western Mounted Brigade
(dismounted) joined the force in March and took the place
at Minia of the Highland Mounted Brigade which moved
south to Sohag and Assiut. Another dismounted brigade
of the Welsh Border and South Wales Yeomanry with the
Welsh Border Mounted Field Ambulance, also joined the
force towards the end of March, and went to Wardan.

Colonel R. H. Luce, A.D.M.S. of the 2nd Mounted Division,
was appointed A.D.M.S. of the Force, with Major G. C. Taylor
as D.A.D.M.S.

The medical units were as follows : —

Scottish Horse Field Ambulance . . . . Mena.

1st Highland Mounted Brigade F.A. .-. . . Sohag.

North Midland Mounted ,, ,, . . . . Fayum.

Field Ambulances, 53rd Division . . . . Wadi Nat-

run and
Wardan.

Australian Light Horse F.A. . . . . . . Wadi Nat-

run.

South Western Mounted Brigade F.A. . . . . Minia.

No. 53 CCS. attached to Command . . . . Wardan.

There were Government hospitals at Fayum, Minia and
Beni Suef, where the headquarters of the Force moved from
Cairo on 17th February 1916, and where Lieut. -Colonel Leiper
was attached for duty in connexion with investigations into
bilharziasis. His laboratory was in the Kasr-el-Aini Hospital,
Cairo.

State hospitals at various other posts, such as Assiut, Sohag,
Kena, Esna and Assouan, were also gradually opened for the
reception of British sick and wounded as the force took up
positions from north to south in the Nile Valley. The arrange-
ments, which had already been in existence in other parts of
Egypt, for the use of the State hospitals prevailed. A certain
number of beds was placed at the disposal of British troops in
each hospital according to estimated requirements. The
administration remained entirely in the hands of the Egyptian
Principal Medical Officer, but where it was convenient an
English nursing sister was appointed as matron with the neces-
sary staff of nurses under her. A R.A.M.C medical officer

OPERATIONS IN SOUTHERN EGYPT 403

was attached to each hospital with a personnel of R.A.M.C.
orderlies as required. The R.A.M.C. medical officer had
medical charge of all British soldiers and was responsible
for the discipline of patients and orderlies. The R.A.M.C.
personnel, both officers and men, was furnished from the
various field ambulances with the Force.

On 2nd March 1916 troops were moved to the Assiut area,
and camps were formed at Minia, Deirut, Assiut, Sohag,
Girga and Luxor along the Nile Valley railway.

At the beginning of April the Southern Force was merged
into the Western Frontier Force, on the completion of the
Solium operations by the latter, and Colonel Luce then became
A.D.M.S. Western Force, with Major C, P. Thompson as
D.A.D.M.S., and Major Taylor as Sanitary Officer. Major
Thompson only remained a short time as he was recalled for
duty with the Public Health Department a fortnight later,
Major Taylor taking his place as D.A.D.M.S. The head-
quarters returned to Cairo from Beni Suef , and Solium, Matruh,
Dabaa and Hammam became stations in the Command.

The only other medical unit then added to the Force
was No. 16 Stationary Hospital, which had detachments at
Solium, Matruh and Dabaa. The Force was divided into
two subordinate commands, a Northern consisting of the
Western Coastal area, Wadi Natrun, Fayum and the Nile Valley
as far as Minia, and a Southern, consisting of the Nile Valley
south of Minia. An A.D.M.S., Lieut. -Colonel Evatt, ad-
ministered medically the Northern section, and a S.M.O.,
Lieut. -Colonel J. W. Mackenzie, the Southern section.

A Governor of the Western Frontier was appointed, with
Major McAllan, R.A.M.C, as his- principal medical officer at
Matruh.

There was little activity on the Western front subsequently,
but various changes in the medical units took place.

No. 53 CCS. left the force in May 1916 and No. 54 joined it
in September 1916. The medical arrangements consisted of
the establishment of a series of hospitals in the Nile Valley,
including No. 54 CCS., which went to Minia. It left, however,
on the 3rd December 1916 for the Canal Zone. Field ambul-
ances equipped with desert ambulance transport were attached
to the columns moving to the Western oases, and railway
coaches were fitted for sick and wounded on the railways
running westwards from the main line in the Nile Valley.
The field ambulances also opened camp hospitals for treatment
of slighter cases at all the principal camps. These hospitals

404 MEDICAL HISTORY OF THE WAR

were tented except in one or two instances when reed huts
were constructed. Cases requiring special or prolonged treat-
ment, and all venereal cases, were sent to the general hospitals
at Cairo. During the hot weather a considerable number of
men were also sent to convalescent hospitals in Cairo.

For evacuation of sick from the field ambulance camp
hospitals to the State hospitals, and from the State hospitals
to Cairo, full use was made of the railways. On each of the
oases railways, namely on the Wadi Natrun and Kharga lines,
an improvised hospital coach was in use. These coaches were
formed by fitting up a passenger coach with stretchers sup-
ported on slings according to Zavodovski's method. Each
coach took twelve patients arranged in two tiers, and this
allowed for a small area at one end of the coach where water,
medical comforts, and dressings could be stored, and where
warm drinks could be provided by means of a Primus stove.
One R.A.M.C. orderly was in charge of the coach. On the
main line a similar coach was used for collecting sick and
conveying them to the hospitals at Sohag and Assiut. Another
similar coach was employed regularly on the coast line between
Dabaa and Alexandria to evacuate the sick from the various
posts along that line. Sitting cases were evacuated by
ordinary trains. On four different occasions one of the regular
hospital trains was used in time of pressure to evacuate the
accumulations of sick from the State hospitals. From the
coastal stations of Matruh and Solium sick were evacuated by
the hospital ship " Raschid."

In the local conveyance of sick motor ambulance cars were
used in Fayum and in the larger towns of Minia and Assiut
where there were fair roads. The local roads of Upper Egypt
were almost entirely made along the sides of the irrigation
canals. Mud from the bottom of the canals was used to make
these roads. When dry and carefully supervised they made
fair motor roads, but in wet weather they were quite im-
passable for motor traffic . In the actual desert, cars could
be used with great advantage, but the surface varied greatly
in different districts, and also in different parts of the same
district. In many parts there were wide stretches of the
best possible going, in others where the limestone was near
the surface, and where the sand had been swept off it, it was
very stony and damaged the tyres. In other places where
the sand had drifted the cars often stuck in the soft sand. For
desert work it was found necessary to have cars with high
axle clearance and high engine power relative to weight. The

OPERATIONS IN SOUTHERN EGYPT 405

expedient of carrying four long boards with bevelled ends on
to which the wheels of the car could be lifted when stuck in
soft sand proved a most effective method of extricating them
from difficulties . On the whole it was proved by experience
that there were few parts of the western desert which could
not be made accessible to motor ambulance cars. It was,
however, sometimes necessary to make long detours to find a
practicable road.

All the medical units were equipped with sand carts and
camel cacolets for transport of sick. Sand carts were most
useful where motor cars could not go. There was little need
to have recourse to camel cacolets for the routine work of
evacuating sick. For the expeditions which were prepared
for the advance to Baharia and Dakhla, cacolets were provided
in considerable number, as it was doubtful if motor ambulance
cars could be got through the sand dunes which bar the roads,
and the carrying of water for mules necessitated the cutting
down of mule-drawn sand carts to a minimum. An attempt
was made to apply camel draught to sand carts, but it was
not very satisfactory. Ordinary ambulance wagons were
useless for desert work, but were used in some parts of
Upper Egypt where the roads were too bad for motor
ambulance cars.

The troops on the whole were healthy. The percentage
of ration strength admitted to hospital weekly varied for the
whole force from 1-5 per cent, to 3- 1 per cent., but the highest
local records reached 12-93 per cent, and 8-9 per cent at one
time, owing to a very extensive outbreak of sandfly fever at
Assiut and Minia, the symptoms resembling influenza. On
the whole the troops stood the hot summer in camp remarkably
well. Their general condition and moral suffered very little,
though it was thought that European troops would not be
able, to stand the heat of Upper Egypt in summer. The men
were worked very lightly, and orders were issued that no
avoidable duty should be carried out between the hours of
9 a.m. and 5 p.m. during the summer months.

The Western Force was amalgamated with the Delta District
to form the Delta and Western Force District on 15th March
1917. Colonel Luce had left the Force a month earlier to take
up the appointment of A.D.M.S., Imperial Mounted Division
in the Eastern Force, Desert Column, and his D.A.D.M.S.,
Major G. C. Taylor, was then left in administrative charge.

The medical situation may be followed by reference to the
sketch map in the previous chapter.

(10134) II

406 MEDICAL HISTORY OF THE WAR

The Medical Services during the Operations against the Sultan

of Darfur.

The Darfur operations were conducted by a force of 165
officers and 3,079 other ranks. The medical personnel were
5 British and 10 Egyptian officers and 93 other ranks of the
Egyptian Army Medical Corps. Major A. G. Cummins,
R.A.M.C, accompanied the column as A.D.M.S., and Captain
C. Cassidy was in medical charge of the advanced troops. Two
sections of an Egyptian field hospital, a casualty clearing
station, and a section of a Camel Box Field Hospital* of the
Egyptian Army organization, formed the medical units of
the force. Each of the battalions or other units had two
panniers.

aaa/nst theSu/tan ofDarfur/9/6.

SceiBefmfcs. Khart0

tOO 50 O IOO

f-ll lr | l lll | k-

Meut./mw/*/

!i_Nahuo.
(Advanced BaseJ.

Route fo/lowed by th* cofomn — — —

In the first phase, the occupation of Um Shanga and Jebel-
el-Hilla, a detachment of one of the field hospital sections
with two Egyptian officers and ten other ranks accompanied
the Force. An Egyptian officer had medical charge of the
Camel Corps with a pair of panniers. Medical Corps orderlies
with haversacks were with the Camel Corps companies and
with the artillery, engineers and mounted infantry detachments.
The casualty clearing station was at the advanced base El
Nahud, about 150 miles from railhead. All medical personnel
and equipment were carried on trotting camels.

During the second phase, involving the occupation of the
line of wells from Jebel-el-Hilla to Abiad, the remaining field

* The Egyptian Field Hospital was a recent organization, in which the equip-
ment was in light loads of 50 lbs. each, capable of being carried by bearer or
pack transport. The Camel Box Field Hospital was the old organization
with equipment in heavy loads in boxes 150 lbs. each for camel transport
only.

OPERATIONS AGAINST DARFUR 407

hospital section and the casualty clearing station were moved
up to Jebel-el-Hilla. The sick were evacuated to the Camel
Box Hospital Section, which was transferred from the railhead
at El Obeid to El Nahud. During the advance a complete
field hospital section with one British and two Egyptian officers
accompanied the column.

The final phase, terminating in the occupation of El Fasher,
required a special medical organization. A British maxim
gun section manned by men of the R.G.A., a detachment of
mounted infantry, three batteries of artillery, four companies
Camel Corps, a Sudanese and Arab battalion formed the
force. The medical unit was one field hospital section. An
Egyptian medical officer and eight orderlies of the Medical
Corps were attached to units, and a R.A.M.C. orderly to the
maxim gun section.

A section of a field hospital was brought up from El Obeid
to El Nahud, and the Camel Box Section from El Nahud to
Jebel-el-Hilla, relieving the casualty clearing station there,
which was advanced to Abiad. Major Parsons Smith, R.A.M.C,
was placed in charge of all medical arrangements along this
line of communication. It was arranged that the casualty
clearing station should move to El Fasher whenever it was
occupied and set free the field hospital section for further
operations with the column.

Camel transport was used entirely for personnel and equip-
ment. Camel cacolets and wheeled stretchers were employed
as ambulance transport. The wheeled stretchers were drawn
by camels, for which a simple form of harness was devised.
One camel could pull unloaded two of the wheeled stretcher
carriers, which thus formed a four-wheeled vehicle. A spare
camel was led with it, to be harnessed to one of the carriers
when loaded.

During the action of Beringia, which was fought on 22nd
May, the day before the column entered El Fasher, the medical
units were in the centre of the square formation.* Tents were
rapidly pitched, and within twenty minutes after the fighting
had ceased all the wounded were under cover and attended to.
The numbers of wounded were 1 British and 2 Egyptian officers
and 18 other ranks. Two of the rank and file were killed.
All the wounds were caused by solid lead -450 bullets fired
from a Remington or Gras type rifle. There was only one

* In the centre of the square the ground fell to a hollow, and the field
hospital was thus well under cover, although the tops of the tents, which were
exposed, were riddled with bullets.

408

MEDICAL HISTORY OF THE WAR

case of subsequent suppuration. The wounded were taken
on in the wheeled stretcher carriers and cacolets to El Fasher,
and a hospital established there in buildings. On the 26th May
the casualty clearing station came up from Abiad, and a
large number of enemy wounded were brought in and treated
in it. About fifty were serious cases and in a septic condition.
The enemy had been in massed formation about 12,000 strong,
and had attacked the square on two 'faces, many coming to
within 20 yards of it.

These successful operations were carried out over a waterless
tract of country, consisting of open rolling downs with scattered
bush. The surface, never very hard, became heavy and loose
in places, rendering marching slow and tiring. In some
areas the bur of the " heskaneet," a thorny grass, got into
puttees, blankets and socks, the small thorns entering the
skin and giving rise to localized abscesses.

The weather was very hot, but few men fell out on the
march. Water was the chief difficulty, only six quarts daily
for each man being allowed for all purposes on the line of
march. One difficulty arose from the water in the metal
water-bottles becoming too hot to drink.

The Maxim Section consisted of fifteen rank and file, all
old British soldiers, with previous experience of service in hot
climates. They were mounted on trotting camels. No
serious disease occurred amongst them, but minor ailments
such as diarrhoea and mild fevers were common.

The rations were good and sufficient, fresh meat being
available at all times. A field force canteen was brought up
and luxuries such as sugar and tobacco could then be purchased.
One ounce of lime-juice was issued twice weekly when fresh
vegetables were unobtainable.

The sick statistics were as follows : —

March.

April.

May.

Number of admissions

Average daily sick

Percentage daily sick to strength

1-38

115

2-19

172

2-64

The Camel Corps had the largest number of admissions,
chiefly on account of venereal disease, which accounted for
nearly half of the sickness.

In the Arab battalion there was a considerable amount of
pneumonia, but otherwise the health of the men was excellent.
This battalion had neither blankets nor ground sheets, and the
medical officers attributed the incidence of pneumonia to this.

CHAPTER XXI.

THE MEDICAL SERVICES DURING THE OPERATIONS IN THE
SINAI PENINSULA.

UNTIL the Egyptian Expeditionary Force was formed after
the withdrawal from the Dardanelles in 1916, no operations
were conducted with a view to driving the enemy out of the
Sinai Pensinsula. On the other hand, enemy forces approached
the Suez Canal from time to time, and the medical arrangements
in this area were concerned with the provision of medical
assistance at the various defensive posts along the Canal
banks, and with the organization and supervision of sanitary
services.

The medical units during this early period were the field
ambulances, which came from India in November and December
1914 for service with the two new Indian divisions, the Indian
Imperial Service Cavalry Brigade and the Bikanir Camel Corps.

When it was known that a large body of the enemy had
entered the Sinai Peninsula early in January 1915, medical
preparations were made for the impending attack on the Canal.
The Indian field ambulances, or sections of them, were dis-
tributed to the various defensive posts. They were provided
with camel cacolets and sand carts for ambulance transport,
to enable them to accompany the patrols. Barges for con-
veyance of wounded were prepared at Port Said under Major
Heron, of the Egyptian Medical Service.

Wounded in No. 1 Section of the Canal Defences were to
be taken to the Civil Hospital in Suez, in No. 2 Section by
launch or rail to Ismailia, and in No. 3 Section by launch or
rail to Port Said. The three hospital trains were in garage,
one at Port Said and two at Zagazig. No. 4 Train, manned
by personnel from one of the Indian General Hospitals, was
kept at Cairo.

A clearing hospital of 100 beds for Indians was organized
at Ismailia by a section of No. 5 Indian General Hospital,
and another for Dominion, British and naval units by the
Australian Clearing Hospital. At Port Said there were two
sections of one of the Indian field ambulances and an Australian
stationary hospital.

410 MEDICAL HISTORY OF THE WAR

Two clearing hospitals were prepared by the Egyptian
Public Health Department, one at Ismailia and one at Suez,
for wounded Turkish prisoners, as noted in Chapter XIX.

During the attacks on 3rd and 4th February 1915, the
number of wounded was comparatively small. They were
all cleared to Ismailia and from there by train to Cairo.

During the remaining months of 1915 the chief work of the
medical services in the Canal Zone was in connexion with
the sanitation of the camps, the reception of Indian sick and
wounded from France and the Dardanelles, and their eva-
cuation in hospital ships or transports from Suez to India.
For administrative purposes the 10th and 11th Indian Divisions
were amalgamated, and the staff for medical services then con-
sisted of Colonel Robinson, I.M.S., as D.D.M.S., Lieut.-Colonel
Burden, I.M.S., as A.D.M.S., Captain Whitworth Jones as
D.A.D.M.S., and Major Graham as D.A.D.M.S. (Sanitation).

There was much difficulty in maintaining a good standard
of sanitation in the camps. The sick-rate was high, especially
on account of dysentery.

The personnel of the Indian field ambulances was constantly
depleted to find reinforcements for Indian medical units in
the Dardanelles, and to supply staffs for transports employed
as carriers of sick and wounded, and, generally speaking, the
Indian medical units were nearly disorganized by this dis-
tribution of their personnel and also by sections of some being
transferred to places widely apart, such as the Western frontier
in Egypt, the Dardanelles and Salonika.

Congestion in the Indian hospitals was great, owing to the
programme of evacuation to India being irregularly carried
out, and the number of hospital ships available being in-
sufficient. The reinforcement drafts from India and Australia
brought with them many men who were suffering from diseases
or otherwise unfit for service, and these too added to the
congestion in the medical units. A convalescent camp for
Indians was consequently established at Suez to relieve the
hospitals.

During July 1915, when Indian brigades were transferred
to Aden, Mesopotamia and the Dardanelles, two weak
Indian brigades and the Bikanir Camel Corps were the
only Indian formations left on the Canal. The gaps were
then filled by Yeomanry units. The situation remained
unaltered until the expeditionary force returned from the
Dardanelles, and the Canal defences came under the command of
the Mediterranean Expeditionary Force on 24th January 1916.

'3.28*ee soeo/iti 1500.11 £3

OPERATIONS IN THE SINAI PENINSULA 411

Preliminary arrangements were then commenced for moving
troops east of the Canal. Roads and a Decauville railway
were pushed on from Kantara towards the Katia district, and
from Port Said to Mehamdiya on the coast north of Katia and
Romani, pending the construction of a broad gauge railway.
Water convoys on camel transport were also organized to
supply water to the troops until a pipe-line from the Sweet
Water Canal was laid. At this time the medical arrangements
were somewhat confused owing to the original Canal defence
arrangements becoming mixed up with the medical arrange-
ments of the Dardanelles force then concentrating and being
reorganized in the Canal Zone.

The camps were in bad condition, and new camps were
being occupied east of the Canal before their sanitary
arrangements were ready, and much work had to be done to
bring the medical and sanitary services into some kind of
order for the advance.

The D.M.S. of the Force for the time being was Surg.-General
W. G. Bedford, with Colonel Keble as his A.D.M.S., and Colonel
Melville as A.D.M.S. (Sanitation). Surg.-General Maher suc-
ceeded Surg.-General Bedford in April 1916, and as the dual
command in Egypt had then been abolished and Surg.-General
Ford, the D.M.S. , Egypt, had left, he became the D.M.S. for
all the military medical services in Egypt and its frontiers,
with his headquarters at Ismailia. At that time there were
in Egypt 11,162 hospital beds for British troops, exclusive
of the accommodation in the Indian and Egyptian hospitals.
There was also accommodation for 4,646 convalescents.

In February and March 1916, there were no active hostilities
beyond reconnaissance of the enemy situation in the Sinai
Peninsula.

There was a large number of medical units in the zone,
many of them in a stage of transfer to other theatres of war.
They were distributed as follows : —

Medical Units in the Canal Zone in February 1916.

Suez Section.
At Suez .. .. No. 5 Indian General Hospital.

Nos. 17 and 18 Stationary Hospitals.
No. 11 Casualty Clearing Station.
No. 16 Sanitary Section.
No. 6 Advanced Depot Medical Stores.
Pathological Laboratory.

At ShcUlufa . . No. 35 Casualty Clearing Station.
No. 22 Sanitary Section.

412

MEDICAL HISTORY OF THE WAR

At El Kubri .. No. 14 Casualty Clearing Station.
No. 30 Sanitary Section.
" C " Section No. 137 Indian Field Ambulance.

At El Shatt and Ain Indian field ambulances.
Musa.

A t Ismailia
Moascar.

and

At Serapeum

At Port Said .

A t Kantara

At El Ferdan . .

At Ballah

At Tel-el-Kebir . .

Ismailia Section.
No. 1 Australian Stationary Hospital.
New Zealand Stationary Hospital.
No. 2 Australian Casualty Clearing Station.
No. 8 Base Depot Medical Stores.
No. 7 Advanced Depot Medical Stores.
Nos. 24 and 30 Sanitary Sections.

Two sections No. 124 Indian Combined Field Ambulance.
Bacteriological Laboratory.

No. 1 Australian Casualty Clearing Station.
Australian Sanitary Section.

Port Said Section.

No. 31 General Hospital.

No. 15 Stationary Hospital.

No. 26 Casualty Clearing Station.

No. 28 Sanitary Section.

No. 5 Advanced Depot Medical Stores.

Bacteriological Laboratory.

No. 54 Casualty Clearing Station.
No. 71 Sanitary Section.

No. 24 Casualty Clearing Station.
No. 21 Sanitary Section.

No. 18 Sanitary Section.

No. 2 Australian Stationary Hospital.

Field ambulances were with divisions, generally with
brigades.

When the Canal Sections were organized for an active
defence, No. 3 Section based on Kantara became the Mobile
Column, with Colonel Girvin as D.D.M.S. There were then
in No. 3 Section or in the Canal area No. 31 General Hospital,
in the Canal works on the east of the Canal at Port Said, No. 5
Advanced Depot Medical Stores at Port Said, No. 26 CCS. at
Kantara East, No. 2 Australian Stationary Hospital at Ismailia
and No. 24 Stationary Hospital at Moascar. There was a
sanitary section at Port Said, Kantara and Moascar. Field
ambulances were with their divisions, the 42nd, 52nd and
53rd, and mounted field ambulances with the Australian and
New Zealand Mounted Division, and with the Yeomanry
brigade, which formed the mobile forces for the advance into
the Katia district. In April mounted troops were occupying

OPERATIONS IN THE SINAI PENINSULA 413

outposts in and beyond Katia,but were attacked on 23rd April
1916, with the loss of three and a half squadrons of Yeomanry
at Oghratina and Katia, as already narrated.

After the enemy attack in April the British line was with-
drawn to Dueidar, and formed an entrenched position from
the coast at Mehamdiya to Romani and Katib Gannit, until
the railway line was sufficiently advanced for a move farther
east. This was the situation on the 4th August when the
enemy attacked in force and the battle of Romani was fought.

The Turks had concentrated in the neighbourhood of Katia
and on that date attacked the British line from the east, south
and south-west. Fighting continued till the 12th August,

-% '

jyj

- W _ d gf*^

£ Ijgjj

^,~^P^

'J$L'

- ->

Camel cacolets as used in Sinai and Palestine.

the enemy being driven back with great loss, and forced to
retire to El Arish. His casualties were estimated as 9,000
out of a for/e of 18,000. The captures included 4,000 prisoners
and two Complete field hospitals.

The situation at the time of the battle was as follows.
Romani was railhead, being connected by a narrow gauge
line with the broad gauge line, which had then reached Gilban.
A narrow gauge branch line also ran from Gilban to Dueidar,
and another from Mehamdiya to the east bank of the Canal
at Port Said along the coast. A metalled road had been
constructed from Kantara to Gilban, and the narrow gauge
railway was continued along this road as far as Kantara
alongside the broad gauge. The 42nd Division was on the
left in the trenches at Mehamdiya and Romani, with one

(10134; n*

414

MEDICAL HISTORY OF THE WAR

brigade on a hill farther back near Pelusium. A brigade of
the 53rd Division was north of Romani, and the 52nd Division
in the trenches between Romani and Katib Gannit. The
Australian and New Zealand Mounted Division and Yeomanry
brigade were on the right flank between Katib Gannit and
Dueidar. The ground over which the battle was fought
was loose sand and undulating, and the heat excessive, so that
the men suffered much, especially from thirst.

Dressing stations were established by the 42nd Division at
Mehamdiya and Pelusium, and by the 52nd Division at Romani
railhead and Bir-el-Maler, south-west of it.

Sand cart as used in Sinai and Palestine.

The majority of the wounded were in the Australian and
New Zealand Mounted Division. Its A.D.M.S., Colonel
R. M. Downes, had four mounted field ambulances with him,
ihe New Zealand, and 1st, 2nd and 3rd Australian Light
Horse Field Ambulances. Just before the battle mobile
sections of these field ambulances were organized with eight
sand carts each, together with a number of camel cacolets
and litters and sand sledges. These were to go out with the
brigades and form advanced dressing stations. The tent
divisions were immobile and remained in positions farther
back as main dressing stations : that of the 1st Light Horse
Field Ambulance at Romani, and that of the 2nd Light Horse
Field Ambulance at one of the outposts ; they evacuated
through No. 3 Lowland Field Ambulance of the 52nd Division,

OPERATIONS IN THE SINAI PENINSULA 415

which acted as a casualty clearing station at railhead. The
3rd Light Horse Field Ambulance was on the hill near
Pelusium, and the New Zealand Mounted Field Ambulance
formed a main dressing station at Canterbury Post south of
Pelusium.

On the 5th August the Light Horse Field Ambulances moved
forward and collected several enemy wounded, establishing
dressing stations west of Katia and at Bir Majid, 6 miles
south of Katib Gannit. A Turkish field ambulance had
been captured and was kept at Hod el Seifania, about 3
miles south-west of Katib Gannit, for the collection and

Camel litters as used during operations in Sinai.

treatment of the enemy wounded. The New Zealand
Mounted Field Ambulance went forward to Bir el Nuss, east
of Dueidar.

On the 6th August the 5th Mounted Brigade Field Ambul-
ance of Yeomanry joined the Anzac Mounted Division. It
opened a dressing station at Katia. Up till then the Yeomanry
brigade wounded were brought to the Anzac Mounted Division
or infantry field ambulances.

The camel ambulance transport of the field ambulances
was formed into ambulance convoys, which came up and
cleared the casualties to the 52nd or 42nd Division dressing
stations on or near the railway.

The number of casualties received by the Anzac Mounted
Division field ambulances during the battle and the pursuit
up to the 13th August is shown in the following table.

416

MEDICAL HISTORY OF THE WAR

Unit.

Wounded .

Sick.

Enemy
Wounded.

Total.

1st Li^ht Horse Field Ambulance

2nd „

3rd

N.Z. Mounted

5th ,, Brigade ,,

150
334

72
141

247

147

129

208
710
134
180
212

Total

740

524

180 1,444

The total British casualties from all units were 18 officers
and 204 other ranks killed and 75 officers and 834 other ranks
wounded.

There were 16 casualties in the Australian Medical Corps
personnel, 3 officers were wounded, 1 dying of wounds ; 12
other ranks were wounded and 1 killed.

The chief difficulty was the want of a portable stretcher
for cavalry, resulting in the necessity of bringing sand carts
and sledges close up to the firing line. The sledges were of
great value for bringing in the seriously wounded, as were
also the sand carts. Camel transport was found to be un-
suitable in front of the main dressing stations, and was only
used, as noted above, to form ambulance convoys between
the main dressing stations and railhead. The sand carts
and sledges were employed between the advanced dressing
stations near the firing line and the main dressing stations.

The regimental organization in the Anzac Mounted Division
broke down, as the regimental stretcher bearers in many
instances were taken by the commanding officer from the
control of the regimental medical officer and ordered into the
firing line. The result was that wounded were carried back
by untrained men, the medical officers were unable to form
aid posts under cover, and sand carts had consequently to be
pushed forward into the firing line. There was also con-
siderable confusion due to messages reaching the dressing
station from different sources asking for sand carts to be sent
up to collect wounded, but when two or more sand carts went
forward it was to find that all the messages related to one
wounded man only. These indiscriminate messages were the
result of the breakdown of the regimental organization and
they thus caused much unnecessary work both to men and
horses

During this battle no hospital trains were sent east of the
Canal, and the casualties had to be evacuated on open trucks

OPERATIONS IN THE SINAI PENINSULA 417

by the light railway from Mehamdiya to Port Said, and from
Romani railhead and Pelusium to Kantara. No. 31 General
Hospital on the east bank of the Canal at Port Said received
the wounded from Mehamdiya, and No. 26 Casualty Clearing
Station those arriving at Kantara East. The wounded in
them were evacuated by motor cars from the latter to hospital
trains at Kantara West or to hospital barges on the Canal,
and distributed to hospitals in Egypt, chiefly to the Australian
Stationary Hospital in the Canal Company's school at Ismailia
and to No. 24 Stationary Hospital at Moascar.

After the battle the Desert Column, chiefly composed of
mounted troops, held an advanced line from Bir-el-Abd,
15 miles east of Katia, southwards to Homossia. The infantry
returned to the Romani-Mehamdiya positions.

On the 16th and 17th September a reconnaissance in force
was carried out by the Desert Column against the enemy
camp at El Mazar, about 25 miles east of Bir-el-Abd ; the
casualties were slight.

After this no important operations were carried out by the
Eastern Force until the end of 1916, but reconnaissance in
the Sinai Peninsula continued to be made by cavalry and the
Bikanir Camel Corps, which reconnoitred for 65 miles east of
Ismailia on the 13th to 17th October. The railway was
pushed on to Bir-es-Salmana, 4 miles east of Bir-el-Abd. By
the 26th November 1916 it had reached El Mazar. Recon-
naissance was then made to within 3 miles of El Arish. The
enemy withdrew from El Arish without fighting and that
town was occupied by the British forces on the 21st December
1916.

The chief difficulty of the advance to El Arish was the
water supply. The pipe-line did not reach Romani till the
17th November 1916 and water had to be carried forward in
tank trucks by the railway to fill improvised storage tanks
at all posts where there was no local water supply. Con-
sequently before the advance to El Arish water had to be
accumulated at the railhead. After El Arish had been occupied
supplies were sent there by sea.

On the 7th December the Desert Column came under the
command of Lieut. -General Sir P. Chetwode, who, after the
occupation of El Arish, pursued the enemy in the direction
of Magdhaba and El Auja, the former some 20 miles south-
east of El Arish, and the latter about 25 miles due east
of Magdhaba. An action was fought at Magdhaba on the
23rd December 1916 and the post was captured with a loss

418 MEDICAL HISTORY OF THE WAR

of 12 officers and 134 other ranks killed and wounded.
1,282 of the enemy were taken prisoners. A permanent and
well-equipped hospital was found in Magdhaba.

The enemy was now in an entrenched position in front of
and around Rafa, and operations were undertaken by the
Desert Column on the night of the 8th/9th January 1917 to
capture it. After considerable resistance, Rafa was occupied
before 11 a.m. on the 9th January. Fighting was continued
and the enemy finally driven out of the Sinai Peninsula.
The number of wounded prisoners captured was 1,600 ; the
British losses were 71 killed and 415 wounded and 1 missing.

The railway line was then pushed out along the coast, and
reached El Arish at the end of January and Rafa in the middle
of March 1917.

During the period between the battle of Romani and the
occupation of Rafa several changes took place in the organiza-
tion of the medical services and their administration. The
D.M.S. moved to Cairo from Ismailia with the G.H.Q. of the
Egyptian Command on the 25th September 1916, and the
forces composing the Canal Defences and in the Sinai Peninsula
were formed into an Eastern Force under the command of
Lieut. -General Sir C. Dobell. The advanced guard of this
force, composed of mounted troops and an infantry division,
formed the Desert Column. The Egypt L. of C. was absorbed
into G.H.Q., and Colonel Sexton, who had been its D.D.M.S.,
was appointed D D.M.S. of the Eastern Force with head-
quarters at Ismailia. Major Bagshawe was appointed A.D.M.S.
on his staff. He had under his administrative medical control
the Canal Sections, each with a D.D.M.S. or A.D.M.S., and
the D.D.M.S. of the Desert Column. He had also direct
administrative control over certain hospitals and other medical
units in all sections of the Canal, and also in the Province of
Sharquia. The A.D.M.S. for Egyptian Hospitals was also
under his administrative control.

When the line advanced the three sections of the Canal were
divided into a Northern and Southern Section ; the Northern
Section became the line of communication under the Eastern
Force from Kantara to railhead.

In this way there appears to have been more than one
D.D.M.S. under the administrative control of the D.D.M.S.
of the Eastern Force.

There was also apparently, partly under the D.D.M.S.,
Eastern Force, and partly under the D.M.S. at G.H.Q. , the
D.D.M.S., Indian Troops, who had control of the Indian

OPERATIONS IN THE SINAI PENINSULA 419

medical units, no matter where they were placed, and who
was more especially engaged in directing the evacuation of
Indians from Egypt to India.

Colonel C. J. Macdonald, who had been D.D.M.S. of No. 3
Section of the Canal, was appointed D.D.M.S. of the Desert
Column, with Major Lelean as his A.D.M.S. Colonel Macdonald
had had considerable experience of warfare in France, and at
once commenced to organize the medical services of the Column.
He introduced systematic and methodical arrangements for
the work of the medical services in connexion with specific
operations. For this purpose the G.O.C. of the Column,
Sir P. Chetwode, kept him fully informed of his plans in advance.
On the 9th October 1916 he held a conference with the
A.Ds.M.S. of the Anzac Mounted Division, 52nd Division and
42nd Division, which then formed the Desert Column Their
methods had been neither definite nor uniform, and there was a
tendency to employ horse and camel transport too far forward,
in some cases almost up to the aid posts. Colonel Macdonald
consequently arranged that advanced dressing stations should
be at a distance of from 500 to 2,000 yards, according to the
nature of the ground, from the aid posts, sufficiently near,
that is to say, for the R.A.M.C. stretcher bearers to carry
wounded from the aid posts to the advanced dressing stations,
and that there should be an animal transport rendezvous
farther back from which the transport could move forward to
the advanced dressing stations when circumstances permitted.
The number of R.A.M.C. stretcher bearers was six squads for
a brigade, but this was considered insufficient, and the
D.D.M.S. asked for double that number. Advanced and main
dressing stations were to be formed by the mobile sections of
the field ambulances, and ambulance convoys were to operate
between the dressing stations and railhead, which would never
be more than 15 miles distant. At railhead a reception hospital
would be formed by the immobile sections of the field ambu-
lances, for accommodation and treatment of cases pending
evacuation by train. In other words, these immobile sections
were to act as casualty clearing stations.

Colonel Macdonald considered it best to retain the immobile
sections of field ambulances at railhead, where they could
supplement the work of any casualty clearing station that
might be established there, and at the same time be ready to
move on camel transport farther forward when necessary.
The casualty clearing stations were being moved by rail and
had therefore to remain on the railway line.

420 MEDICAL HISTORY OF THE WAR

By the beginning of December four casualty clearing stations
were placed along the line, No. 24 at Bir-el-Abd, No. 26 at El
Mazar, and Nos. 53 and 54 at railhead. The last two were kept
packed ready to move. The accommodation in the two casualty
clearing stations that were open was for 800, obviously in-
adequate for a force then numbering some 50,000. Con-
sequently two stationary hospitals were demanded, one for
Kantara and the other for Romani. No. 24 Stationary
Hospital was then moved, in November, from Moascar to
Kantara East, and No. 2 (Australian) Stationary Hospital
from Port Said to Mehamdiya instead of to Romani, with the
accommodation in each increased to 800 beds.

No hospital trains crossed to the east of the Canal until
December, when No. 6 and an emergency train were ready,
the latter being replaced by No. 7 Train on the 14th December.

The medical situation in the Desert Column, therefore, before
the advance to and occupation of El Arish was as follows : —

At Railhead .. The immobile sections of divisional field ambulances,
with accommodation for 700 casualties.

At El Abd .. No. 24 Clearing Casualty Station open for 400, Nos. 53

and 54 Casualty Clearing Stations parked with equipment
for 200 each.

At El Mazar .. No. 26 Casualty Clearing Station open for 400.

At Mehamdiya . . No. 2 (Australian) Stationary Hospital for 800 beds.

At Kantara East No. 24 Stationary Hospital for 800 beds.

The total accommodation was, therefore, for 3,500. It was
less than the number of anticipated casualties, and everything
depended on the means of rapid evacuation to Kantara and
Egypt.

Two hospital trains, Nos. 6 and 7, and equipment for im-
provising an emergency train were available. Evacuation by
the Mehamdiya-Port Said route did not prove of much use.
Mehamdiya had been selected as a hospital centre in order to
divert evacuation to that route and avoid the more direct
route to Kantara, as the latter was likely to be congested with
traffic. The line, however, from Romani to Mehamdiya was
constantly being blocked by sand drifts, and this interfered
with its being used as the regular line of evacuation.

Evacuation by sea was considered, but it was found
impossible to make use of hospital ships from any point on
the coast-line of Sinai.

Extra personnel for loading trains and for work at the
casualty clearing stations was obtained from bearer sections
of the Egyptian Labour Corps. These sections were organized
in July 1916, and trained under the A.D.M.S., Egyptian

OPERATIONS IN THE SINAI PENINSULA 421

Hospitals, and the commandant of the Corps. They formed a
reserve of bearers, who proved to be excellent workers and
invaluable during the succeeding battles.

No. 8 Base Depot of Medical Stores was moved to Kantara.

Changes were effected in order to define the responsibility
for the medical services. When No. 3 Section of the Canal
became the Northern Section, its area extending from
Kantara to Port Said and along the Sinai railway to El
Arish, the zone in front of El Arish came under the Desert
Column command. The headquarters of the Northern Section
was then at El Arish, and the section was administered medi-
cally by a D.A.D.M.S. (Captain J. H. Wood) under the D.D.M.S.
of the Eastern Force. His duties were to organize the evacua-
tion of the sick and wounded along the line and supervise the
sanitation of the town and camps. These arrangements held
good until after the Second Battle of Gaza in April 1917.

For the operations against Magdhaba in December 1916,
after the occupation of El Arish, medical units were improvised
to accompany the Imperial Camel Corps Brigade. A mounted
mobile section was formed from the 1/lst Welsh Field Am-
bulance of the 53rd Division. The personnel was mounted on
camels, carrying 48 spare cacolets, and 9 sand carts were
allotted to the field ambulance. A second camel corps
ambulance was improvised on the same lines on the 20th
December. Each camel corps company had in addition a pair
of cacolets and a medical orderly.* The ordinary ambulance
transport of a field ambulance mobile section at the time
consisted of 9 sand carts, 38 cacolets and 10 litters.

In the Magdhaba action there were 131 wounded, of whom
30 were serious cases, in the Anzac Mounted Division. In
addition, 64 enemy wounded, 15 serious, were brought in.
The railhead was at El Mazar, where No. 26 CCS. was open
and where No. 54 CCS. had also come up from El Abd,
together with the immobile sections of the field ambulances.
Railhead was then some 16 miles across the desert, and in order
to avoid this journey the D.D.M.S. was anxious to bring the
wounded to El Arish and send them back by the supply ships.
The D.M.S., G.H.Q., however, issued an order that no seriously
sick or wounded should be sent back in these ships. The

* The Scottish Horse Field Ambulance replaced the ambulance improvised
from the 1/lst Welsh Field Ambulance on the 9th January 1917. It had
been sent to Jeddah in August 1916, and had returned to Egypt without dis-
embarking. Its transport consisted of 18 camel cacolets and 30 litters ; it had
no sand carts or sledges.

422 MEDICAL HISTORY OF THE WAR

slight cases, however, were embarked and sent to No. 31
Gene